MEDICARE: P26 NON-SW FL PLLC

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	:	1609674209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P26 NON-SW FL PLLC

Provider Business Mailing Address
First Line	:	681 GOODLETTE-FRANK RD N STE 110
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-5612
Country	:	US
Telephone Number	:	239-687-6339
Fax Number	:

Provider Business Practice Location Address
First Line	:	9010 STRADA STELL CT STE 101
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-4425
Country	:	US
Telephone Number	:	239-254-4480
Fax Number	:

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	DR. JOHN ALBERT COSTELLO
Credential	:	DMD
Telephone Number	:	239-687-6339

Provider Enumeration Date	:	03/07/2025
Last Update Date	:	07/11/2025

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