Provider Demographics
NPI:1649230210
Name:SOUTHWEST FLORIDA ORAL & FACIAL SURGERY
Entity type:Organization
Organization Name:SOUTHWEST FLORIDA ORAL & FACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING INSURANCE CORRDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:2399-938-3025
Mailing Address - Street 1:8267 COLLEGE PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5193
Mailing Address - Country:US
Mailing Address - Phone:239-938-3025
Mailing Address - Fax:239-936-1954
Practice Address - Street 1:8267 COLLEGE PARKWAY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5193
Practice Address - Country:US
Practice Address - Phone:239-938-3025
Practice Address - Fax:239-936-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU18366Medicare UPIN
FL63536Medicare ID - Type Unspecified
FL40442Medicare ID - Type UnspecifiedGROUP NUMBER