Provider Demographics
NPI:1730337098
Name:ENT ASSOCIATES OF BROWARD LLC
Entity type:Organization
Organization Name:ENT ASSOCIATES OF BROWARD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMEBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-755-8885
Mailing Address - Street 1:9311 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4101
Mailing Address - Country:US
Mailing Address - Phone:954-755-8885
Mailing Address - Fax:
Practice Address - Street 1:8130 ROYAL PALM BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5703
Practice Address - Country:US
Practice Address - Phone:954-345-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10414207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty