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Organization
NOVA SOUTHEASTERN UNIVERSITY, INC
Active
Organization
NOVA SOUTHEASTERN UNIVERSITY, INC
Active
Parent organization
NOVA SOUTHEASTERN UNIVERSITY, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
NOVA SOUTHEASTERN UNIVERSITY, INC
Authorized official
ROBERT S OLLER D.O. (CEO CLINICAL OPERATIONS)
(954) 262-4343
Entity
Organization
Contact information
Practice address
830 E OAKLAND PARK BLVD, OAKLAND PARK, FL 33334-2761
(954) 262-7530
(954) 568-7749
Mailing address
3200 S UNIVERSITY DR, SANFORD L. ZIFF BLDG. 3RD FLOOR ROOM 4364-D, FT. LAUDERDALE, FL 33328-2018
(954) 262-4343
(954) 262-2269
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
—
—
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000521601
—
FL
Enumeration date
09/23/2008
Last updated
06/24/2011
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