Organization
DENTAL SPECIALTY CENTER OF FT. MYERS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE GOMEZ (PROVIDER RELATIONS SPECIALIST)
(305) 274-2499
Entity
Organization
Contact information
Practice address
7011 CYPRESS TER, SUITE 101, FORT MYERS, FL 33907-8800
(239) 433-3075
Mailing address
13195 SW 134 ST, 2ND FLOOR, MIAMI, FL 33186
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223E0200X
Endodontics
—
—
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
11/27/2012
Last updated
08/06/2014
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