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General NPI Number Information
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NPI Number | 1386799534
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Entity Type | Organization
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Legal Business Name | SUNCOAST DENTAL CENTER
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 06/04/2018
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Provider Practice Location Address
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Address Line | 13040 LIVINGSTON RD SUITE 3
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City | NAPLES
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State | FL
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Zip | 34105
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Country | US
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Telephone | 239-566-2255
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Fax | 239-566-1788
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Provider Business Mailing Address
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Address Line | 13040 LIVINGSTON ROAD SUITE 3
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City | NAPLES
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State | FL
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Zip | 34105
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Country | US
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Telephone | 239-566-2255
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Fax | 239-566-1788
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Authorized Official
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Title or Position | DENTIST/PRESIDENT
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Name | DR. KEVIN E GOODLET
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Credential | DMD
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Telephone | 239-566-2255
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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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