Provider Demographics
NPI:1568793727
Name:SOUTHWEST FLORIDA DENTAL PARTNERSHIP
Entity Type:Organization
Organization Name:SOUTHWEST FLORIDA DENTAL PARTNERSHIP
Other - Org Name:SOUTHWEST FLORIDA DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:BAXMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-489-1118
Mailing Address - Street 1:15650 SAN CARLOS BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-2569
Mailing Address - Country:US
Mailing Address - Phone:239-489-1118
Mailing Address - Fax:239-489-3627
Practice Address - Street 1:15650 SAN CARLOS BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-2569
Practice Address - Country:US
Practice Address - Phone:239-489-1118
Practice Address - Fax:239-489-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN148251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty