MEDICARE: CORAL DENTAL AND DENTURE 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	DN 19837	FL

General Provider Information

NPI Number	:	1366796450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORAL DENTAL AND DENTURE PA

Provider Business Mailing Address
First Line	:	12711 MCGREGOR BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-4412
Country	:	US
Telephone Number	:	239-542-3925
Fax Number	:	239-210-5903

Provider Business Practice Location Address
First Line	:	12711 MCGREGOR BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-4412
Country	:	US
Telephone Number	:	239-542-3925
Fax Number	:	239-210-5903

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JUAN CARLOS CASTELLANOS
Credential	:	DDS
Telephone Number	:	239-603-5210

Provider Enumeration Date	:	10/29/2012
Last Update Date	:	04/28/2016

Similar Medicare Providers

1790637288 — Z HEALTH SOLUTION
Practice Location Address:

12717 MCGREGOR BLVD UNIT 1
FORT MYERS, FL
33919-4412

Practice Phone: 239-703-9790
Practice Fax:

1891866687 — DR. HEATHER ALTHEA ADU-SARKODIE DDS, PHD
Practice Location Address:

12711 MCGREGOR BLVD
FORT MYERS, FL
33919-4412

Practice Phone: 239-728-3636
Practice Fax: 239-693-3637

1184672164 — DR. SAMERAH G RAZUMAN M.D.
Practice Location Address:

2000 HARTMAN RD STE 1
FORT PIERCE, FL
34947-4412

Practice Phone: 772-465-1170
Practice Fax: 772-465-1171

1811947765 — GERARD Q FLORES MD PLLC
Practice Location Address:

2000 HARTMAN RD STE 2
FORT PIERCE, FL
34947-4412

Practice Phone: 772-465-1170
Practice Fax: 772-465-1171

1790889509 — CVS PHARMACY INC
Practice Location Address:

9620 WHITE SETTLEMENT RD
FORT WORTH, TX
76108-4412

Practice Phone: 817-246-2411
Practice Fax: 817-246-2621

1871749390 — SARAH M GREBENC
Practice Location Address:

1892 VETERANS WAY
FORT HARRISON, MT
59636-4412

Practice Phone: 406-447-7740
Practice Fax:

Directions to “CORAL DENTAL AND DENTURE PA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.