Provider Demographics
NPI:1477941383
Name:LEFTY GOLF, INC.
Entity Type:Organization
Organization Name:LEFTY GOLF, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ADAMS
Authorized Official - Last Name:GREIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:239-267-5000
Mailing Address - Street 1:18070 S TAMIAMI TRL
Mailing Address - Street 2:101
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4602
Mailing Address - Country:US
Mailing Address - Phone:239-267-5000
Mailing Address - Fax:
Practice Address - Street 1:18070 S TAMIAMI TRL
Practice Address - Street 2:101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4602
Practice Address - Country:US
Practice Address - Phone:239-267-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty