Provider Demographics
NPI:1891886719
Name:COMMUNITY DENTAL PRACTICES, LLC
Entity Type:Organization
Organization Name:COMMUNITY DENTAL PRACTICES, LLC
Other - Org Name:RIVERDALE DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARKUS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:239-694-9993
Mailing Address - Street 1:14651 PALM BEACH BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-2331
Mailing Address - Country:US
Mailing Address - Phone:239-694-9993
Mailing Address - Fax:239-694-9995
Practice Address - Street 1:14651 PALM BEACH BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-2331
Practice Address - Country:US
Practice Address - Phone:239-694-9993
Practice Address - Fax:239-694-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN80991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty