Provider Demographics
NPI:1598387334
Name:DENTAL SPECIALITY GROUP LLC
Entity Type:Organization
Organization Name:DENTAL SPECIALITY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-206-2008
Mailing Address - Street 1:700 2ND AVE N STE 202
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5701
Mailing Address - Country:US
Mailing Address - Phone:239-206-2008
Mailing Address - Fax:239-204-4776
Practice Address - Street 1:700 2ND AVE N STE 202
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5701
Practice Address - Country:US
Practice Address - Phone:239-206-2008
Practice Address - Fax:239-204-4776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty