Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | DN22167 | FL |
NPI | 1073966545 |
---|---|
Provider Name | Dr. Bryan Nack |
First Address | Ft Lauderdale, FL 33316-2510 |
Second Address | Ft Lauderdale, FL 33316-2510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2016 |
Last Update Date | 07/03/2019 |