Healthcare Provider Details

I. General information

NPI: 1497195721
Provider Name (Legal Business Name): NEW AGE DENTISTRY OF NAPLES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7550 MISSION HILLS DR STE 122
NAPLES FL
34119-9604
US

IV. Provider business mailing address

7550 MISSION HILLS DR STE 122
NAPLES FL
34119-9604
US

V. Phone/Fax

Practice location:
  • Phone: 239-348-8370
  • Fax: 239-529-5673
Mailing address:
  • Phone: 239-348-8370
  • Fax: 239-529-5673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberDN20197
License Number StateFL

VIII. Authorized Official

Name: JULIA TALALENKO
Title or Position: PRESIDENT/DENTIST
Credential:
Phone: 239-588-0247