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General NPI Number Information
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NPI Number | 1891886719
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Entity Type | Organization
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Legal Business Name | COMMUNITY DENTAL PRACTICES, LLC
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14651 PALM BEACH BLVD SUITE 101
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City | FORT MYERS
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State | FL
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Zip | 33905-2331
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Country | US
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Telephone | 239-694-9993
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Fax | 239-694-9995
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Provider Business Mailing Address
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Address Line | 14651 PALM BEACH BLVD SUITE 101
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City | FORT MYERS
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State | FL
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Zip | 33905-2331
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Country | US
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Telephone | 239-694-9993
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Fax | 239-694-9995
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. MARKUS SHERRY
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Credential | D.M.D.
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Telephone | 239-694-9993
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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 | DN8099
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License Number State | FL
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