MEDICARE: DENTAL DESIGNS OF FORT MYERS, LLC

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	16414	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952540270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL DESIGNS OF FORT MYERS, LLC

Provider Business Mailing Address
First Line	:	3230 FORUM BLVD STE 501
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-5580
Country	:	US
Telephone Number	:	239-628-1300
Fax Number	:	239-262-7970

Provider Business Practice Location Address
First Line	:	3230 FORUM BLVD STE 501
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-5580
Country	:	US
Telephone Number	:	239-628-1300
Fax Number	:	239-262-7970

Authorized Official
Title or Position	:	OWNER/MGR
Name	:	DR. RAMON PADILLA
Credential	:	DDS
Telephone Number	:	239-628-1300

Provider Enumeration Date	:	02/10/2009
Last Update Date	:	04/26/2018

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