Organization
NOVA SOUTHEASTERN UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSEMERY ESTEVEZ (DIR CONTRACTING AND CRED)
(786) 262-4343
Entity
Organization
Contact information
Practice address
819 NE 26TH ST, WILTON MANORS, FL 33305-1239
(954) 567-5650
(954) 561-8556
Mailing address
PO BOX 290250, DAVIE, FL 33329-0250
(954) 262-4343
(954) 262-2269
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
Primary
—
—
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
124Q00000X
Dental Hygienist
—
—
Other
Enumeration date
12/03/2012
Last updated
05/25/2023
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