MEDICARE: PREMIER DENTAL AND ORTHODONTICS OF PORT CHARLOTTE

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	:	1982492765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER DENTAL AND ORTHODONTICS OF PORT CHARLOTTE

Provider Business Mailing Address
First Line	:	970 KINGS HWY UNIT 3
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-4213
Country	:	US
Telephone Number	:	561-420-1378
Fax Number	:

Provider Business Practice Location Address
First Line	:	970 KINGS HWY UNIT 3
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-4213
Country	:	US
Telephone Number	:	561-420-1378
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	CHARITY SLAUGHTER
Credential	:
Telephone Number	:	561-420-1378

Provider Enumeration Date	:	04/30/2025
Last Update Date	:	04/30/2025

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