Healthcare Provider Details

I. General information

NPI: 1366309023
Provider Name (Legal Business Name): ADVANTAGE DENTAL ORAL HEALTH CENTER OF FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5705 LEE BLVD STE 13
LEHIGH ACRES FL
33971-6342
US

IV. Provider business mailing address

PO BOX 410042
BOSTON MA
02241-0042
US

V. Phone/Fax

Practice location:
  • Phone: 239-337-0391
  • Fax:
Mailing address:
  • Phone: 629-666-2488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NEIL WILLIAMS
Title or Position: OWNER
Credential:
Phone: 629-666-2488