Healthcare Provider Details

I. General information

NPI: 1730736174
Provider Name (Legal Business Name): INTEGRITY DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 TAMIAMI TRL N STE 201
NAPLES FL
34103-2810
US

IV. Provider business mailing address

5100 TAMIAMI TRL N STE 201
NAPLES FL
34103-2810
US

V. Phone/Fax

Practice location:
  • Phone: 239-403-4334
  • Fax:
Mailing address:
  • Phone: 239-403-4334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LINDA GORDON
Title or Position: OFFICE MANAGER
Credential:
Phone: 239-403-4334