Eastside Surgical Services, Inc.

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

License

10648 Issued in FL

Legal business name

EASTSIDE SURGICAL SERVICES, INC.

Practice address

5400 N Federal Hwy
Suite 102
Ft Lauderdale, FL 33308-3201

Phone

(954) 771-8772

Fax

(954) 771-8072

NPI assigned

Apr 3, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Leslie Harris Sultan, DMD

Title

Administrator

Phone

(954) 771-8772

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972624344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 N FEDERAL HWY",
            "address_2": "SUITE 102",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333083201",
            "telephone_number": "954-771-8772",
            "fax_number": "954-771-8072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 N FEDERAL HWY",
            "address_2": "SUITE 102",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333083201",
            "telephone_number": "954-771-8772",
            "fax_number": "954-771-8072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE SURGICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SULTAN",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_middle_name": "HARRIS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "954-771-8772",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "10648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery Clinic/Center in Ft Lauderdale, FL
• Providers in Ft Lauderdale, FL by specialty
• Oral and Maxillofacial Surgery Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.