Healthcare Provider Details

I. General information

NPI: 1265913784
Provider Name (Legal Business Name): DENTISTS OF SOUTH NAPLES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6839 COLLIER BLVD STE 103
NAPLES FL
34114-3632
US

IV. Provider business mailing address

PO BOX 920050
DALLAS TX
75392-0050
US

V. Phone/Fax

Practice location:
  • Phone: 239-206-1659
  • Fax: 239-206-1659
Mailing address:
  • Phone: 714-845-8280
  • Fax: 303-952-0892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. MINH B PHAM
Title or Position: OWNER/DDS
Credential: DDS
Phone: 239-209-1659