Provider Demographics
NPI:1952540270
Name:DENTAL DESIGNS OF FORT MYERS, LLC
Entity Type:Organization
Organization Name:DENTAL DESIGNS OF FORT MYERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MGR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-628-1300
Mailing Address - Street 1:3230 FORUM BLVD STE 501
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-5580
Mailing Address - Country:US
Mailing Address - Phone:239-628-1300
Mailing Address - Fax:239-262-7970
Practice Address - Street 1:3230 FORUM BLVD STE 501
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-5580
Practice Address - Country:US
Practice Address - Phone:239-628-1300
Practice Address - Fax:239-262-7970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16414261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental