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General NPI Number Information
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NPI Number | 1144629031
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Entity Type | Organization
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Legal Business Name | FAMILY & COSMETIC DENTISTRY
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Dates
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Enumeration Date | 08/18/2014
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Last Update Date | 08/18/2014
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Provider Practice Location Address
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Address Line | 331 CAPE CORAL PKWY W SUITE A
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City | CAPE CORAL
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State | FL
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Zip | 33914-5977
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Country | US
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Telephone | 239-540-2020
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Fax | 239-540-8293
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Provider Business Mailing Address
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Address Line | 331 CAPE CORAL PKWY W SUITE A
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City | CAPE CORAL
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State | FL
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Zip | 33914-5977
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Country | US
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Telephone | 239-540-2020
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Fax | 239-540-8293
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRETT A VARTDAL
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Credential | DMD
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Telephone | 239-540-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN13901
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License Number State | FL
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