MEDICARE: TOOTH39 DENTAL GROUP PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1487462081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOOTH39 DENTAL GROUP PLLC

Provider Business Mailing Address
First Line	:	15455 COLLIER BLVD UNIT 104
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-7874
Country	:	US
Telephone Number	:	239-258-4245
Fax Number	:	239-467-6050

Provider Business Practice Location Address
First Line	:	15455 COLLIER BLVD UNIT 104
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-7874
Country	:	US
Telephone Number	:	239-258-4245
Fax Number	:	239-467-6050

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RUBEN LEONARDO KREBS
Credential	:	DDS
Telephone Number	:	239-258-4245

Provider Enumeration Date	:	12/28/2024
Last Update Date	:	12/28/2024

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