Organization
KING BENJAMIN DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLY MOURITSEN (SOLE MEMBER)
(239) 251-5045
Entity
Organization
Contact information
Practice address
3467 PINE RIDGE RD STE 101, NAPLES, FL 34109-3832
(239) 251-5045
Mailing address
18589 SARASOTA RD, FORT MYERS, FL 33967-3520
(239) 240-5886
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
10/11/2024
Last updated
10/11/2024
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