Healthcare Provider Details

I. General information

NPI: 1831981505
Provider Name (Legal Business Name): JCR DMD LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26831 S TAMIAMI TRL UNIT 48
BONITA SPRINGS FL
34134-7828
US

IV. Provider business mailing address

3751 TAMIAMI TRL E
NAPLES FL
34112-6215
US

V. Phone/Fax

Practice location:
  • Phone: 239-399-0925
  • Fax: 239-304-8134
Mailing address:
  • Phone: 239-399-0925
  • Fax: 239-304-8134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSE C RAMIREZ
Title or Position: OWNER
Credential: DMD
Phone: 786-916-7400