# FSP FL OFS PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Dental Implant and Facial Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821954330
- **Authorized official:** JENNIFER HOCK (DIRECTOR OF PAYOR RELATIONS)
- **Authorized official phone:** (704) 295-4653

## Contact information

- **Practice address:** 2600 E COMMERCIAL BLVD STE 200, FT LAUDERDALE, FL 33308-4125
- **Practice address phone:** (954) 566-0330
- **Mailing address:** 2600 E COMMERCIAL BLVD STE 200, FT LAUDERDALE, FL 33308-4125
- **Mailing address phone:** (954) 566-0330

## Taxonomy

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

## Other

- **Enumeration date:** 12/29/2025
- **Last updated:** 12/29/2025