Healthcare Provider Details

I. General information

NPI: 1487559688
Provider Name (Legal Business Name): DENTISTS ON CORTEZ, P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7627 CORTEZ ROAD W, SUITE 102
BRADENTON FL
34210
US

IV. Provider business mailing address

PO BOX 660041
DALLAS TX
75266-0041
US

V. Phone/Fax

Practice location:
  • Phone: 941-422-0764
  • Fax: 941-462-3892
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 StateNULL

VIII. Authorized Official

Name: AMELIA CRAWFORD
Title or Position: OWNER
Credential: DMD
Phone: 941-422-0764