Healthcare Provider Details

I. General information

NPI: 1487149167
Provider Name (Legal Business Name): SCOTT DELBOCCIO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1729 HERITAGE TRL # 904
NAPLES FL
34112-7591
US

IV. Provider business mailing address

1729 HERITAGE TRL # 904
NAPLES FL
34112-7591
US

V. Phone/Fax

Practice location:
  • Phone: 239-304-1917
  • Fax:
Mailing address:
  • Phone: 239-304-1917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SCOTT DELBOCCIO
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 239-304-1900