MEDICARE: DR. BRENDAN MARK DWYER DDS

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	1223G0001X	General Practice Dentistry	DN8932	FL

General Provider Information

NPI Number	:	1659420032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENDAN MARK DWYER DDS

Provider Business Mailing Address
First Line	:	16601 SAN CARLOS BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-3953
Country	:	US
Telephone Number	:	239-466-3131
Fax Number	:	239-466-6195

Provider Business Practice Location Address
First Line	:	16601 SAN CARLOS BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-3953
Country	:	US
Telephone Number	:	239-466-3131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	03/01/2010

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