Healthcare Provider Details

I. General information

NPI: 1578697553
Provider Name (Legal Business Name): RODOLFO PUTZEYS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3722 CENTRAL AVE. STE. I
FORT MYERS FL
33901-8247
US

IV. Provider business mailing address

3722 CENTRAL AVE. STE. I
FORT MYERS FL
33901-8247
US

V. Phone/Fax

Practice location:
  • Phone: 239-274-7687
  • Fax: 239-275-1801
Mailing address:
  • Phone: 239-274-7687
  • Fax: 239-275-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN0013261
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: