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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
1750 NE 167TH STREET, NORTH MIAMI BEACH, FL 33162-3017
(954) 262-4100
(954) 262-1666
Mailing address
3200 S. UNIVERSITY DRIVE, 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
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
075174000
—
FL
Enumeration date
02/04/2009
Last updated
06/16/2011
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