Organization
FANTASEA PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOANA LASTRES D.M.D (OWNER)
(239) 594-1171
Entity
Organization
Contact information
Practice address
1890 SW HEALTH PKWY STE 104, NAPLES, FL 34109-0473
(239) 594-1171
Mailing address
1890 SW HEALTH PKWY STE 104, NAPLES, FL 34109-0473
(239) 594-1171
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN21762
FL
Other
Enumeration date
07/20/2017
Last updated
07/21/2022
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