Healthcare Provider Details

I. General information

NPI: 1477016111
Provider Name (Legal Business Name): KEY DENTAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 BURTWOOD DR
FORT MYERS FL
33901-8714
US

IV. Provider business mailing address

700 2ND AVE N STE 202
NAPLES FL
34102-5701
US

V. Phone/Fax

Practice location:
  • Phone: 239-268-0700
  • Fax: 239-204-4776
Mailing address:
  • Phone: 239-230-2033
  • Fax: 239-204-4776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ALAN FARRUGIA
Title or Position: OWNER
Credential:
Phone: 239-230-2033