Healthcare Provider Details

I. General information

NPI: 1730793720
Provider Name (Legal Business Name): ENGLE IMPLANT DENTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2020
Last Update Date: 09/07/2020
Certification Date: 09/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 9TH ST N
NAPLES FL
34102-5203
US

IV. Provider business mailing address

5659 NAPLES BLVD
NAPLES FL
34109-2023
US

V. Phone/Fax

Practice location:
  • Phone: 239-213-1500
  • Fax:
Mailing address:
  • Phone: 239-593-2178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY ENGLE
Title or Position: DENTIST
Credential:
Phone: 239-593-2178