# JASON E. PORTNOF DMD, MD, PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Las Olas Centre for Oral & Maxillofacial Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699190280
- **Authorized official:** DR. JASON E PORTNOF DMD, MD (OWNER)
- **Authorized official phone:** (954) 983-1899

## Contact information

- **Practice address:** 100 SE 15TH AVE, FT LAUDERDALE, FL 33301-3985
- **Practice address phone:** (954) 983-1899
- **Practice address fax:** (954) 986-6846
- **Mailing address:** 100 SE 15TH AVE, FT LAUDERDALE, FL 33301-3985
- **Mailing address phone:** (954) 983-1899
- **Mailing address fax:** (954) 318-3215

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DN16048 | FL | Yes |

## Other

- **Enumeration date:** 02/19/2014
- **Last updated:** 01/25/2017