Provider Demographics
NPI:1417389883
Name:NAPLES DENTAL STUDIO, LLC
Entity Type:Organization
Organization Name:NAPLES DENTAL STUDIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:CLINTON
Authorized Official - Last Name:GOSS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:239-262-4595
Mailing Address - Street 1:730 GOODLETTE RD N
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5616
Mailing Address - Country:US
Mailing Address - Phone:239-262-4595
Mailing Address - Fax:239-649-6702
Practice Address - Street 1:730 GOODLETTE RD N
Practice Address - Street 2:SUITE 206
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5616
Practice Address - Country:US
Practice Address - Phone:239-262-4595
Practice Address - Fax:239-649-6702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN105061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty