Healthcare Provider Details

I. General information

NPI: 1639008139
Provider Name (Legal Business Name): QUEANH PHAN DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8855 IMMOKALEE RD UNIT 10
NAPLES FL
34120-3928
US

IV. Provider business mailing address

8855 IMMOKALEE RD UNIT 10
NAPLES FL
34120-3928
US

V. Phone/Fax

Practice location:
  • Phone: 239-348-3079
  • Fax: 239-348-2338
Mailing address:
  • Phone: 239-348-3079
  • Fax: 239-348-2338

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. QUEANH PHAN
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 239-250-3445