Healthcare Provider Details

I. General information

NPI: 1457286668
Provider Name (Legal Business Name): HEART DENTAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16520 BURNT STORE RD UNIT 104
PUNTA GORDA FL
33955-9220
US

IV. Provider business mailing address

16520 BURNT STORE RD UNIT 104
PUNTA GORDA FL
33955-9220
US

V. Phone/Fax

Practice location:
  • Phone: 941-548-6684
  • Fax:
Mailing address:
  • Phone: 941-548-6684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: OLIVER GUILLERMO CABRERA
Title or Position: OWNER
Credential: DDS
Phone: 585-576-5864