Organization
BROWARD COUNTY DENTAL SURGERY PA
Active
Organization
BROWARD COUNTY DENTAL SURGERY PA
Active
Parent organization
BROWARD COUNTY DENTAL SURGERY PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
BROWARD COUNTY DENTAL SURGERY PA
Authorized official
DR. JOHN R CLARKE DMD (PRESIDENT BROWARD COUNTY DENTAL SUR)
(954) 562-9610
Entity
Organization
Contact information
Practice address
5181 NE 19 AVE, FT LAUDERDALE, FL 33308
(954) 562-9610
(954) 772-2569
Mailing address
PO BOX 11223, FT LAUDERDALE, FL 33339
(954) 562-9610
(954) 772-2569
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN5272
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
070653100
—
FL
Enumeration date
08/01/2012
Last updated
12/17/2012
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