Healthcare Provider Details

I. General information

NPI: 1861357444
Provider Name (Legal Business Name): CORTEZ DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4016 CORTEZ RD W STE 1101
BRADENTON FL
34210-3117
US

IV. Provider business mailing address

4016 CORTEZ RD W STE 1101
BRADENTON FL
34210-3117
US

V. Phone/Fax

Practice location:
  • Phone: 941-756-4999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: PETER KELLY
Title or Position: OWNER
Credential:
Phone: 941-745-4999