Provider Demographics
NPI:1861877979
Name:THE CENTER FOR FACIAL RESTORATION, INCORPORATED
Entity type:Organization
Organization Name:THE CENTER FOR FACIAL RESTORATION, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:954-442-5191
Mailing Address - Street 1:1951 SW 172ND AVENUE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5613
Mailing Address - Country:US
Mailing Address - Phone:954-442-5191
Mailing Address - Fax:786-228-2853
Practice Address - Street 1:1951 SW 172ND AVENUE
Practice Address - Street 2:SUITE 205
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5613
Practice Address - Country:US
Practice Address - Phone:954-442-5191
Practice Address - Fax:786-228-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64358207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1346275443OtherINDIVIDUAL NPI