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General NPI Number Information
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NPI Number | 1609674209
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Entity Type | Organization
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Legal Business Name | P26 NON-SW FL PLLC
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 9010 STRADA STELL CT STE 101
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City | NAPLES
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State | FL
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Zip | 34109-4425
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Country | US
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Telephone | 239-254-4480
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Fax |
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Provider Business Mailing Address
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Address Line | 681 GOODLETTE-FRANK RD N STE 110
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City | NAPLES
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State | FL
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Zip | 34102-5612
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Country | US
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Telephone | 239-687-6339
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Fax |
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | DR. JOHN ALBERT COSTELLO
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Credential | DMD
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Telephone | 239-687-6339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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