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General NPI Number Information
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NPI Number | 1891977310
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Entity Type | Organization
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Legal Business Name | LASER DENTISTRY, INC.
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 1550 MATTHEW DR
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City | FORT MYERS
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State | FL
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Zip | 33907-1733
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Country | US
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Telephone | 239-936-5442
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Fax | 239-936-4478
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Provider Business Mailing Address
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Address Line | 1550 MATTHEW DR
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City | FORT MYERS
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State | FL
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Zip | 33907-1733
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Country | US
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Telephone | 239-936-5442
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Fax | 239-936-4478
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Authorized Official
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Title or Position | OFFICER
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Name | MRS. TERRY MONICA CORKE
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Credential | RDH
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Telephone | 239-936-5442
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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 | DN14551
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License Number State | FL
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