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General NPI Number Information
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NPI Number | 1518664721
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Entity Type | Organization
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Legal Business Name | FAMILIAR DENTISTRY PA
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Dates
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Enumeration Date | 02/08/2023
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 7740 PRESERVE LN STE 11
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City | NAPLES
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State | FL
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Zip | 34119-9710
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Country | US
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Telephone | 239-359-6136
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Fax |
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Provider Business Mailing Address
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Address Line | 14040 DANPARK LOOP
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City | FORT MYERS
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State | FL
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Zip | 33912-6864
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Country | US
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Telephone | 786-296-5235
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. RAFAEL MARTINEZ
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Credential | DMD
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Telephone | 786-296-5235
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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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