Healthcare Provider Details

I. General information

NPI: 1063973410
Provider Name (Legal Business Name): COMFORT DENTAL IMPLANT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 239-230-2033
  • Fax: 239-230-2034
Mailing address:
  • Phone: 239-230-2033
  • Fax: 239-230-2034

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 Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALAN FARRUGIA
Title or Position: OWNER
Credential:
Phone: 850-450-8935