Organization
JASON E. PORTNOF DMD, MD, PA
Active
Other names
Las Olas Centre for Oral & Maxillofacial Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON E PORTNOF DMD, MD (OWNER)
(954) 983-1899
Entity
Organization
Contact information
Practice address
100 SE 15TH AVE, FT LAUDERDALE, FL 33301-3985
(954) 983-1899
(954) 986-6846
Mailing address
100 SE 15TH AVE, FT LAUDERDALE, FL 33301-3985
(954) 983-1899
(954) 318-3215
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN16048
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HA085Z
MEDICARE PTAN
FL
Enumeration date
02/19/2014
Last updated
01/25/2017
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