Healthcare Provider Details

I. General information

NPI: 1194322651
Provider Name (Legal Business Name): PETER TSAMBAZIS DMD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6654 COLLIER BLVD UNIT 104
NAPLES FL
34114-8179
US

IV. Provider business mailing address

26670 ROSEWOOD POINTE CIR UNIT 102
BONITA SPRINGS FL
34135-7534
US

V. Phone/Fax

Practice location:
  • Phone: 917-692-3160
  • Fax:
Mailing address:
  • Phone: 917-692-3160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER TSAMBAZIS
Title or Position: PRESIDENT
Credential: DMD
Phone: 917-692-3160