=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255718987
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENTAL SOLUTIONS FOR SENIORS,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2015
-----------------------------------------------------
Last Update Date | 05/01/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1172 GOODLETTE RD N SUITE 101
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34102-5430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-261-1909
-----------------------------------------------------
Fax | 239-263-2167
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1172 GOODLETTE RD N SUITE 101
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34102-5430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-261-1909
-----------------------------------------------------
Fax | 239-263-2167
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGER
-----------------------------------------------------
Name | DR. ANNA MARIE AVOLA
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 239-261-1909
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | DN 8028
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------