Provider Demographics
NPI:1417385543
Name:PINE PLAZA DENTAL CARE, INC
Entity Type:Organization
Organization Name:PINE PLAZA DENTAL CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDORI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-455-0221
Mailing Address - Street 1:12435 COLLIER BLVD
Mailing Address - Street 2:SUITE #105
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-6041
Mailing Address - Country:US
Mailing Address - Phone:239-455-0221
Mailing Address - Fax:239-455-7859
Practice Address - Street 1:12435 COLLIER BLVD
Practice Address - Street 2:SUITE #105
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-6041
Practice Address - Country:US
Practice Address - Phone:239-455-0221
Practice Address - Fax:239-455-7859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 12445261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental