Provider Demographics
NPI:1013354174
Name:GULFSHORE ORAL SURGERY, PA
Entity Type:Organization
Organization Name:GULFSHORE ORAL SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:FONTANA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:239-262-3300
Mailing Address - Street 1:1585 PINE RIDGE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2105
Mailing Address - Country:US
Mailing Address - Phone:239-262-3300
Mailing Address - Fax:239-262-3333
Practice Address - Street 1:1585 PINE RIDGE RD STE 2
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2105
Practice Address - Country:US
Practice Address - Phone:239-262-3300
Practice Address - Fax:239-262-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty