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General NPI Number Information
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NPI Number | 1609770197
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Entity Type | Organization
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Legal Business Name | SKYBLUE WD LLC
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 2139 SKYLINE BLVD STE B
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City | CAPE CORAL
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State | FL
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Zip | 33991-3674
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Country | US
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Telephone | 239-666-4090
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Fax |
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Provider Business Mailing Address
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Address Line | 2139 SKYLINE BLVD STE B
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City | CAPE CORAL
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State | FL
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Zip | 33991-3674
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Country | US
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Telephone | 239-666-4090
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Fax |
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Authorized Official
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Title or Position | CEO/CO-OWNER
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Name | DAVID RUA PEREZ
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Credential | DMD MDS
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Telephone | 786-328-9108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State | NULL
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