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General NPI Number Information
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NPI Number | 1902175771
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Entity Type | Organization
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Legal Business Name | DENTAL SLEEP MEDICINE OF SOUTHWEST FLORIDA LLC
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Dates
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Enumeration Date | 12/22/2011
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Last Update Date | 12/22/2011
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Provider Practice Location Address
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Address Line | 3001 DEL PRADO BLVD S
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City | CAPE CORAL
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State | FL
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Zip | 33904-7208
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Country | US
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Telephone | 239-549-8921
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Fax |
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Provider Business Mailing Address
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Address Line | 3001 DEL PRADO BLVD S
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City | CAPE CORAL
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State | FL
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Zip | 33904-7208
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Country | US
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Telephone | 239-549-8921
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MARK PHILLIP KRAVER
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Credential | D.D.S.
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Telephone | 239-549-8921
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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 | 19091
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11408
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License Number State | FL
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