Healthcare Provider Details

I. General information

NPI: 1265842488
Provider Name (Legal Business Name): ANNA M AVOLA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 PINE RIDGE RD STE F
NAPLES FL
34109-2002
US

IV. Provider business mailing address

2171 PINE RIDGE RD STE F
NAPLES FL
34109-2002
US

V. Phone/Fax

Practice location:
  • Phone: 239-566-7425
  • Fax: 239-593-3430
Mailing address:
  • Phone: 239-566-7425
  • Fax: 239-593-3430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN8028
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: