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General NPI Number Information
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NPI Number | 1366309023
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Entity Type | Organization
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Legal Business Name | ADVANTAGE DENTAL ORAL HEALTH CENTER OF FLORIDA PA
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Dates
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Enumeration Date | 01/06/2026
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 5705 LEE BLVD STE 13
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City | LEHIGH ACRES
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State | FL
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Zip | 33971-6342
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Country | US
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Telephone | 629-666-2488
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 410042
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City | BOSTON
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State | MA
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Zip | 02241-0042
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Country | US
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Telephone | 629-666-2488
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Fax |
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Authorized Official
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Title or Position | SR MANAGER
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Name | SHERRIE EDMONDSON
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Credential |
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Telephone | 615-598-5572
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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 |
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License Number State |
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Taxonomy #2
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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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