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General NPI Number Information
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NPI Number | 1043861776
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Entity Type | Organization
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Legal Business Name | YOUR DENTAL LLC
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Dates
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Enumeration Date | 09/24/2019
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 4959 CASTELLO DR
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City | NAPLES
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State | FL
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Zip | 34103-8927
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Country | US
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Telephone | 239-262-2677
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Fax | 239-261-2670
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Provider Business Mailing Address
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Address Line | 4959 CASTELLO DR
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City | NAPLES
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State | FL
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Zip | 34103-8927
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Country | US
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Telephone | 239-262-2677
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Fax | 239-261-2670
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Authorized Official
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Title or Position | MANAGER
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Name | DR. CHRISTOPHER ANDREW WIDMER
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Credential | D.D.S.
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Telephone | 239-262-2677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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