Provider Demographics
NPI:1669594255
Name:CHILDREN'S DENTISTRY OF NAPLES
Entity type:Organization
Organization Name:CHILDREN'S DENTISTRY OF NAPLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTAL SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-262-3898
Mailing Address - Street 1:3699 AIRPORT PULLING RD N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-8516
Mailing Address - Country:US
Mailing Address - Phone:239-262-3898
Mailing Address - Fax:239-262-2375
Practice Address - Street 1:3699 AIRPORT PULLING RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-8516
Practice Address - Country:US
Practice Address - Phone:239-262-3898
Practice Address - Fax:239-262-2375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00138251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty