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General NPI Number Information
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NPI Number | 1891622262
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Entity Type | Organization
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Legal Business Name | NORTH LAKEWOOD DENTAL
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Dates
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Enumeration Date | 05/07/2026
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Last Update Date | 05/08/2026
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Provider Practice Location Address
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Address Line | 8528 HERITAGE GREEN WAY
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City | BRADENTON
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State | FL
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Zip | 34212-1449
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Country | US
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Telephone | 941-941-0205
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Fax |
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Provider Business Mailing Address
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Address Line | 3448 CLEVELAND AVE
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City | FORT MYERS
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State | FL
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Zip | 33901-7108
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Country | US
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Telephone | 239-936-3436
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | TAMMIE STEPHENS
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Credential |
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Telephone | 239-936-3436
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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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