Individual
OLIVER PETER FAVALLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5150 MASON CORBIN CT, SUITE #2, FORT MYERS, FL 33907
(239) 418-1444
Mailing address
7117 CONGDON ROAD, SUITE 100, FORT MYERS, FL 33908
(239) 418-1444
(239) 418-1888
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
13738
FL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
13738
FL
Other
Enumeration date
08/30/2006
Last updated
05/25/2016
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