| Gulfshore Pediatric Dentistry, P.a. | |
|
9921 Corkscrew Rd Estero FL 33928 | |
| (239) 776-2115 | |
| Not Available |
| Full Name | Gulfshore Pediatric Dentistry, P.a. |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 9921 Corkscrew Rd, Estero, Florida |
| Authorized Official Name and Position | Tia Shea Sammons (PEDIATRIC DENTIST) |
| Authorized Official Contact | 2397762115 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gulfshore Pediatric Dentistry, P.a. 9921 Corkscrew Rd Estero FL 33928 Ph: (239) 776-2115 | Gulfshore Pediatric Dentistry, P.a. 9921 Corkscrew Rd Estero FL 33928 Ph: (239) 776-2115 |
| NPI Number | 1982082335 |
|---|---|
| Provider Enumeration Date | 05/18/2015 |
| Last Update Date | 05/18/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982082335 | NPI | - | NPPES |
| 002138100 | Medicaid | FL | |
| 076870700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | DN17564 (Florida) | Primary |
| 1223P0221X | Dentist - Pediatric Dentistry | (Florida) | Secondary |
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