Healthcare Provider Details

I. General information

NPI: 1871400754
Provider Name (Legal Business Name): DENTISTS ON BONITA BEACH, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 BONITA BEACH RD STE 131
BONITA SPRINGS FL
34134-4165
US

IV. Provider business mailing address

PO BOX 660041
DALLAS TX
75266-0041
US

V. Phone/Fax

Practice location:
  • Phone: 239-206-4814
  • Fax: 239-221-0095
Mailing address:
  • Phone: 714-845-8890
  • Fax: 303-952-0892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DIANA SHIMA
Title or Position: OWNER
Credential: DDS
Phone: 239-206-4814