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General NPI Number Information
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NPI Number | 1225433287
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Entity Type | Organization
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Legal Business Name | AEGEAN DENTAL OF NAPLES, LLC
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Dates
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Enumeration Date | 11/03/2014
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 987 HIGH POINT DR
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City | NAPLES
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State | FL
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Zip | 34103-3877
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Country | US
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Telephone | 239-231-4089
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Fax |
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Provider Business Mailing Address
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Address Line | 987 HIGH POINT DR
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City | NAPLES
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State | FL
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Zip | 34103-3877
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Country | US
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Telephone | 239-231-4089
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | GEORGE SOROPOULOS
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Credential | DDS, BSME
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Telephone | 239-231-4089
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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 | DN15874
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License Number State | FL
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