NPIMap

Organization Active NPI

Nova Southeastern University, Inc

  • General Practice Dentistry
  • Oakland Park, FL
National Provider Identifier
1548410947
Registry record updated Jun 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
NOVA SOUTHEASTERN UNIVERSITY, INC
Practice address
830 E Oakland Park Blvd
Oakland Park, FL 33334-2761
Phone
(954) 262-7530
Fax
(954) 568-7749
NPI assigned
Sep 23, 2008
Last updated
Jun 24, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
NOVA SOUTHEASTERN UNIVERSITY, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 24, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert S Oller, D.O.
Title
Ceo Clinical Operations
Phone
(954) 262-4343

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health Dentistry 1223D0001X
Endodontics 1223E0200X
General Practice Dentistry 1223G0001X Primary
Pediatric Dentistry 1223P0221X
Periodontics 1223P0300X

Addresses

Primary practice location

830 E Oakland Park Blvd
Oakland Park, FL 33334-2761

Mailing address

3200 S University Dr
Sanford L. Ziff BLDG. 3Rd Floor Room 4364-D
Ft. Lauderdale, FL 33328-2018
Phone (954) 262-4343

Other identifiers 1

IdentifierTypeStateIssuer
000521601MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Nova Southeastern Univ38 organizations share this tax ID, including this one
Part of
Nova Southeastern Univ

Other organizations with this tax ID 37

Organizations that report the same tax identification number in the National Provider Directory.

View all 37

Locations

3200 S University Dr
Bldg 3RD
Davie, FL 33328

830 E Oakland Park Blvd
Oakland Park, FL 33334
Phone (954) 262-7530

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308873600000",
    "number": "1548410947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 S UNIVERSITY DR",
            "address_2": "SANFORD L. ZIFF BLDG. 3RD FLOOR ROOM 4364-D",
            "city": "FT. LAUDERDALE",
            "state": "FL",
            "postal_code": "333282018",
            "telephone_number": "954-262-4343",
            "fax_number": "954-262-2269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 E OAKLAND PARK BLVD",
            "city": "OAKLAND PARK",
            "state": "FL",
            "postal_code": "333342761",
            "telephone_number": "954-262-7530",
            "fax_number": "954-568-7749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVA SOUTHEASTERN UNIVERSITY, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NOVA SOUTHEASTERN UNIVERSITY, INC",
        "enumeration_date": "2008-09-23",
        "last_updated": "2011-06-24",
        "status": "A",
        "authorized_official_last_name": "OLLER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO CLINICAL OPERATIONS",
        "authorized_official_telephone_number": "954-262-4343",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000521601",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.