Provider Demographics
NPI:1376237073
Name:BONITA PALM DENTAL
Entity Type:Organization
Organization Name:BONITA PALM DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:OROZCO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-798-2850
Mailing Address - Street 1:11713 GREY TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8633
Mailing Address - Country:US
Mailing Address - Phone:703-798-2850
Mailing Address - Fax:
Practice Address - Street 1:9776 BONITA BEACH RD SE STE 202A
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4775
Practice Address - Country:US
Practice Address - Phone:703-798-2850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty