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Organization
NORTHERN DENTAL GENERAL AND COSMETIC DENTISTRY LLC
Active
Organization
NORTHERN DENTAL GENERAL AND COSMETIC DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON NOVAK (MANAGER)
(239) 431-5666
Entity
Organization
Contact information
Practice address
5651 NAPLES BLVD, NAPLES, FL 34109-2023
(239) 431-5666
Mailing address
5651 NAPLES BLVD, NAPLES, FL 34109-2023
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN20711
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016807000
—
FL
Enumeration date
04/25/2016
Last updated
04/25/2016
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