Healthcare Provider Details

I. General information

NPI: 1417389883
Provider Name (Legal Business Name): NAPLES DENTAL STUDIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 GOODLETTE RD N SUITE 206
NAPLES FL
34102-5616
US

IV. Provider business mailing address

730 GOODLETTE RD N SUITE 206
NAPLES FL
34102-5616
US

V. Phone/Fax

Practice location:
  • Phone: 239-262-4595
  • Fax: 239-649-6702
Mailing address:
  • Phone: 239-262-4595
  • Fax: 239-649-6702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10506
License Number StateFL

VIII. Authorized Official

Name: DR. TRAVIS CLINTON GOSS JR.
Title or Position: OWNER
Credential: DMD
Phone: 239-262-4595