MEDICARE: DR. VICTOR MANUEL PRIETO CAPOTE DMD

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	1223G0001X	General Practice Dentistry	DN29505	FL

General Provider Information

NPI Number	:	1881424471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR MANUEL PRIETO CAPOTE DMD

Provider Business Mailing Address
First Line	:	17171 3 OAKS PKWY UNIT 2324
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33967-5394
Country	:	US
Telephone Number	:	503-498-1584
Fax Number	:

Provider Business Practice Location Address
First Line	:	17171 3 OAKS PKWY UNIT 2324
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33967-5394
Country	:	US
Telephone Number	:	503-498-1584
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2024
Last Update Date	:	08/09/2024

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