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General NPI Number Information
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NPI Number | 1497195721
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Entity Type | Organization
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Legal Business Name | NEW AGE DENTISTRY OF NAPLES INC.
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Dates
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Enumeration Date | 07/01/2013
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Last Update Date | 07/01/2013
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Provider Practice Location Address
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Address Line | 7550 MISSION HILLS DR STE 122
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City | NAPLES
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State | FL
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Zip | 34119-9604
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Country | US
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Telephone | 239-348-8370
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Fax | 239-529-5673
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Provider Business Mailing Address
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Address Line | 7550 MISSION HILLS DR STE 122
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City | NAPLES
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State | FL
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Zip | 34119-9604
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Country | US
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Telephone | 239-348-8370
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Fax | 239-529-5673
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | JULIA TALALENKO
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Credential |
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Telephone | 239-588-0247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | DN20197
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License Number State | FL
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