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General NPI Number Information
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NPI Number | 1518885656
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Entity Type | Organization
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Legal Business Name | SOUTHWEST FLORIDA DENTAL GROUP PA
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Dates
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Enumeration Date | 07/07/2026
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Last Update Date | 07/07/2026
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Provider Practice Location Address
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Address Line | 728 SW PINE ISLAND RD
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City | CAPE CORAL
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State | FL
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Zip | 33991-1969
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Country | US
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Telephone | 239-772-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 19442 THE PLACE BLVD
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City | ESTERO
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State | FL
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Zip | 33928-6585
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Country | US
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Telephone | 770-856-0167
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TYLER GRIFFITH
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Credential | DMD
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Telephone | 770-856-0167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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