MEDICARE: ACCESS ENDODONTICS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	DN21480	FL

General Provider Information

NPI Number	:	1023486313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS ENDODONTICS PA

Provider Business Mailing Address
First Line	:	6323 CORPORATE CT
Second Line	:	SUITE A
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3518
Country	:	US
Telephone Number	:	239-482-5311
Fax Number	:

Provider Business Practice Location Address
First Line	:	6323 CORPORATE CT
Second Line	:	SUITE A
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3518
Country	:	US
Telephone Number	:	239-482-5311
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEVEN FREY
Credential	:	DDS
Telephone Number	:	231-482-5311

Provider Enumeration Date	:	09/03/2015
Last Update Date	:	09/03/2015

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