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General NPI Number Information
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NPI Number | 1205182276
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Entity Type | Organization
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Legal Business Name | PICASSO AESTHETIC AND COSMETIC DENTAL SPA PA
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Dates
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Enumeration Date | 07/27/2012
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 5995 S POINTE BLVD STE 109
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City | FORT MYERS
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State | FL
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Zip | 33919-3273
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Country | US
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Telephone | 239-401-2799
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Fax | 239-320-3288
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Provider Business Mailing Address
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Address Line | 20843 THISTLE LEAF LN
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City | ESTERO
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State | FL
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Zip | 33928-4082
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Country | US
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Telephone | 239-401-2799
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Fax | 239-320-3288
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY RUBIN
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Credential |
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Telephone | 239-370-3343
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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 | DN12852
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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