Organization
CORAL DENTAL AND DENTURE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUAN CARLOS CASTELLANOS DDS (PRESIDENT)
(239) 603-5210
Entity
Organization
Contact information
Practice address
12711 MCGREGOR BLVD, FORT MYERS, FL 33919-4412
(239) 542-3925
(239) 210-5903
Mailing address
12711 MCGREGOR BLVD, FORT MYERS, FL 33919-4412
(239) 542-3925
(239) 210-5903
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN 19837
FL
Other
Enumeration date
10/29/2012
Last updated
04/28/2016
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