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General NPI Number Information
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NPI Number | 1194557033
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Entity Type | Organization
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Legal Business Name | AFFORDABLE DENTURES & IMPLANTS - FORT MYERS, P.A.
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Dates
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Enumeration Date | 08/19/2024
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 4329 CLEVELAND AVE STE 250
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City | FORT MYERS
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State | FL
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Zip | 33901-9085
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Country | US
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Telephone | 239-936-6722
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Fax |
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Provider Business Mailing Address
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Address Line | 4329 CLEVELAND AVE STE 250
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City | FORT MYERS
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State | FL
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Zip | 33901-9085
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Country | US
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Telephone | 239-936-6722
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EDDY ROMERO MATOS
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Credential | DMD
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Telephone | 239-936-6722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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