Organization
GULFSHORE PEDIATRIC DENTISTRY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIA SHEA SAMMONS DMD (PEDIATRIC DENTIST)
(239) 776-2115
Entity
Organization
Contact information
Practice address
9921 CORKSCREW RD, ESTERO, FL 33928
(239) 776-2115
Mailing address
9921 CORKSCREW RD, ESTERO, FL 33928
(239) 776-2115
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN17564
FL
1223P0221X
Pediatric Dentistry
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002138100
—
FL
05
—
076870700
—
FL
Enumeration date
05/18/2015
Last updated
05/18/2015
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