=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497893630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARKLEY CIRCLE DENTAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 BARKLEY CIR
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33907-7531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-939-0423
-----------------------------------------------------
Fax | 239-939-4912
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 BARKLEY CIR
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33907-7531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-939-0423
-----------------------------------------------------
Fax | 239-939-4912
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GREGORY G HILL
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 239-939-0423
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------