Organization
HOLLYWOOD ORTHODONTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FAUSTO NICIEZA DMD (PRESIDENT)
(954) 985-3883
Entity
Organization
Contact information
Practice address
3113 STIRLING RD STE 101, FORT LAUDERDALE, FL 33312-6547
(305) 458-3384
Mailing address
3113 STIRLING RD STE 101, FORT LAUDERDALE, FL 33312-6547
(305) 458-3384
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
10/30/2018
Last updated
10/30/2018
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