Healthcare Provider Details

I. General information

NPI: 1770059693
Provider Name (Legal Business Name): FACULTY ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 GRAND LELY DR
NAPLES FL
34113-1753
US

IV. Provider business mailing address

PO BOX 100425
GAINESVILLE FL
32610-0425
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5801
  • Fax: 352-392-3070
Mailing address:
  • Phone: 352-273-5801
  • Fax: 352-392-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JEAN M SWEITZER
Title or Position: SECRETARY/TREASURER
Credential:
Phone: 352-273-5787