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General NPI Number Information
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NPI Number | 1285971846
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE ORAL HEALTH & WELLNESS, LLC
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Dates
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Enumeration Date | 01/15/2013
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Last Update Date | 01/15/2013
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Provider Practice Location Address
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Address Line | 1187 8TH ST S UNIT 4
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City | NAPLES
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State | FL
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Zip | 34102-7306
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Country | US
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Telephone | 239-289-2881
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Fax | 866-583-2067
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Provider Business Mailing Address
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Address Line | 250 PALM RIVER BLVD APT B102
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City | NAPLES
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State | FL
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Zip | 34110-1102
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Country | US
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Telephone | 239-289-2881
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Fax | 866-583-2067
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Authorized Official
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Title or Position | OWNER/MANAGER/DENTIST
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Name | DR. KRISTIN ELIZABETH OUTLAN
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Credential | DMD
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Telephone | 239-289-2881
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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 | DN 13540
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License Number State | FL
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