Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 716991 | FL |
NPI | 1437196847 |
---|---|
Provider Name | Dr. Todd Jason Sawisch |
First Address | Fort Lauderdale, FL 33308-3810 |
Second Address | Fort Lauderdale, FL 33308-3810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 08/07/2007 |