Organization
BLUM-NICO ORAL FACIAL SURGERY ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFERY D. BLUM DENTIST (OWNER)
(305) 538-4556
Entity
Organization
Contact information
Practice address
4308 ALTON RD STE 850, MIAMI BEACH, FL 33140-4558
(305) 538-4556
(305) 538-2019
Mailing address
4308 ALTON RD STE 850, MIAMI BEACH, FL 33140-4558
(305) 538-4556
(305) 538-2019
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
L11000065863
FL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
L11000065863
FL
Other
Enumeration date
10/19/2011
Last updated
10/19/2011
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