Healthcare Provider Details

I. General information

NPI: 1609674209
Provider Name (Legal Business Name): P26 NON-SW FL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 STRADA STELL CT STE 101
NAPLES FL
34109-4425
US

IV. Provider business mailing address

681 GOODLETTE-FRANK RD N STE 110
NAPLES FL
34102-5612
US

V. Phone/Fax

Practice location:
  • Phone: 239-254-4480
  • Fax:
Mailing address:
  • Phone: 239-687-6339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN ALBERT COSTELLO
Title or Position: VP OF OPERATIONS
Credential: DMD
Phone: 239-687-6339