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NPI Code Detail

MEDICARE: P26 NON-SW FL PLLC

MEDICARE: P26 NON-SW FL 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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1609674209
Entity Type Code : Organization
Provider Name (Legal Business Name) : P26 NON-SW FL PLLC
Provider Business Mailing Address
First Line : 9010 STRADA STELL CT STE 101
Second Line :
City : NAPLES
State : FL
Zip : 34109-4425
Country : US
Telephone Number : 239-687-6339
Fax Number :
Provider Business Practice Location Address
First Line : 9010 STRADA STELL CT STE 101
Second Line :
City : NAPLES
State : FL
Zip : 34109-4425
Country : US
Telephone Number : 239-254-4480
Fax Number :
Authorized Official
Title or Position : COO
Name : DR. JOHN ALBERT COSTELLO
Credential : DMD
Telephone Number : 239-687-6339
Provider Enumeration Date : 03/07/2025
Last Update Date : 02/17/2026

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