Healthcare Provider Details

I. General information

NPI: 1629743232
Provider Name (Legal Business Name): TERESA LYNN OBERLY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3941 TAMIAMI TRL UNIT 3171
PUNTA GORDA FL
33950-7925
US

IV. Provider business mailing address

3941 TAMIAMI TRL UNIT 3171
PUNTA GORDA FL
33950-7925
US

V. Phone/Fax

Practice location:
  • Phone: 941-639-5224
  • Fax: 941-639-3563
Mailing address:
  • Phone: 941-639-5224
  • Fax: 941-639-3563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH28804
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: