MEDICARE: AEGEAN DENTAL OF NAPLES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN15874	FL

General Provider Information

NPI Number	:	1225433287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AEGEAN DENTAL OF NAPLES, LLC

Provider Business Mailing Address
First Line	:	987 HIGH POINT DR
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34103-3877
Country	:	US
Telephone Number	:	239-231-4089
Fax Number	:

Provider Business Practice Location Address
First Line	:	987 HIGH POINT DR
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34103-3877
Country	:	US
Telephone Number	:	239-231-4089
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	GEORGE SOROPOULOS
Credential	:	DDS, BSME
Telephone Number	:	239-231-4089

Provider Enumeration Date	:	11/03/2014
Last Update Date	:	05/06/2015

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