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General NPI Number Information
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NPI Number | 1477941383
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Entity Type | Organization
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Legal Business Name | LEFTY GOLF, INC.
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Dates
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Enumeration Date | 12/30/2014
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 18070 S TAMIAMI TRL 101
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City | FORT MYERS
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State | FL
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Zip | 33908-4602
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Country | US
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Telephone | 239-267-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 18070 S TAMIAMI TRL 101
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City | FORT MYERS
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State | FL
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Zip | 33908-4602
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Country | US
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Telephone | 239-267-5000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM ADAMS GREIDER
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Credential | DMD
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Telephone | 239-267-5000
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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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