MEDICARE: PALM AND PEARL DENTAL 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1194673509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM AND PEARL DENTAL PA

Provider Business Mailing Address
First Line	:	1056 GOODLETTE-FRANK RD N STE 202
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-5490
Country	:	US
Telephone Number	:	239-435-0200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1056 GOODLETTE-FRANK RD N STE 202
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-5490
Country	:	US
Telephone Number	:	239-435-0200
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MINDY FRYE
Credential	:
Telephone Number	:	239-435-0200

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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