MEDICARE: ENGLE DENTISTRY MARCO

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	122300000X	Dentist

General Provider Information

NPI Number	:	1902410996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENGLE DENTISTRY MARCO

Provider Business Mailing Address
First Line	:	5659 NAPLES BLVD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-2023
Country	:	US
Telephone Number	:	239-213-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1845 SAN MARCO RD STE 100
Second Line	:
City	:	MARCO ISLAND
State	:	FL
Zip	:	34145-6712
Country	:	US
Telephone Number	:	239-213-1500
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	BRADLEY ENGLE
Credential	:
Telephone Number	:	392-593-2178

Provider Enumeration Date	:	09/07/2020
Last Update Date	:	09/07/2020

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