Provider Demographics
NPI:1417373762
Name:COSMETIC & IMPLANT DENTISTRY OF NAPLES
Entity Type:Organization
Organization Name:COSMETIC & IMPLANT DENTISTRY OF NAPLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-597-4944
Mailing Address - Street 1:5390 PARK CENTRAL CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-5923
Mailing Address - Country:US
Mailing Address - Phone:239-597-4944
Mailing Address - Fax:239-514-0455
Practice Address - Street 1:5390 PARK CENTRAL CT
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-5923
Practice Address - Country:US
Practice Address - Phone:239-597-4944
Practice Address - Fax:239-514-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN149511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty