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Organization
FSP FL OFS PA
Active
Organization
FSP FL OFS PA
Active
Other names
Dental Implant and Facial Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER HOCK (DIRECTOR OF PAYOR RELATIONS)
(704) 295-4653
Entity
Organization
Contact information
Practice address
2600 E COMMERCIAL BLVD STE 200, FT LAUDERDALE, FL 33308-4125
(954) 566-0330
Mailing address
2600 E COMMERCIAL BLVD STE 200, FT LAUDERDALE, FL 33308-4125
(954) 566-0330
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
12/29/2025
Last updated
12/29/2025
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