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General NPI Number Information
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NPI Number | 1235090366
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Entity Type | Organization
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Legal Business Name | SIESTA DENTAL LLC
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Dates
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Enumeration Date | 11/19/2025
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 416 S TAMIAMI TRL STE F1
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City | OSPREY
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State | FL
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Zip | 34229-9206
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Country | US
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Telephone | 407-375-9838
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Fax | 941-761-6529
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Provider Business Mailing Address
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Address Line | 416 S TAMIAMI TRL STE F1
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City | OSPREY
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State | FL
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Zip | 34229-9206
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Country | US
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Telephone | 407-375-9838
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Fax | 941-761-6529
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIANO DE LA RIVA
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Credential | DDS
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Telephone | 407-375-9838
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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 |
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License Number State |
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