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Organization
MODERN DENTAL CAPE CORAL PLLC
Active
Organization
MODERN DENTAL CAPE CORAL PLLC
Active
Parent organization
MODERN DENTAL, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MODERN DENTAL, LLC
Authorized official
TYLER M BLACKENBURG DMD (PERIODONTIST)
(954) 736-7924
Entity
Organization
Contact information
Practice address
706 SW PINE ISLAND RD, SUITE 103, CAPE CORAL, FL 33991
(941) 610-6200
Mailing address
14575 TAMIAMI TRL STE A, NORTH PORT, FL 34287-2743
(941) 888-2362
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0300X
Periodontics
—
—
Other
Enumeration date
03/17/2020
Last updated
03/17/2020
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