Organization
FSP FL OFS PA
Active
Other names
Dental Implant and Facial Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER HOCK (DIRECTOR OF PAYOR RELATIONS)
(704) 295-4653
Entity
Organization
Contact information
Practice address
2600 E COMMERCIAL BLVD STE 200, FT LAUDERDALE, FL 33308-4125
(954) 566-0330
Mailing address
2600 E COMMERCIAL BLVD STE 200, FT LAUDERDALE, FL 33308-4125
(954) 566-0330
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
12/29/2025
Last updated
12/29/2025
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