| Island Tower Dentistry Pa | |
|
606 Bald Eagle Dr Ste 200 Marco Island FL 34145-2731 | |
| (239) 394-1004 | |
| Not Available |
| Full Name | Island Tower Dentistry Pa |
|---|---|
| Speciality | Dentist |
| Location | 606 Bald Eagle Dr Ste 200, Marco Island, Florida |
| Authorized Official Name and Position | Jonathan Van Dyke (DENTIST) |
| Authorized Official Contact | 2393941004 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Island Tower Dentistry Pa 606 Bald Eagle Dr Ste 200 Marco Island FL 34145-2731 Ph: (239) 394-1004 | Island Tower Dentistry Pa 606 Bald Eagle Dr Ste 200 Marco Island FL 34145-2731 Ph: (239) 394-1004 |
| NPI Number | 1154016178 |
|---|---|
| Provider Enumeration Date | 04/06/2023 |
| Last Update Date | 04/06/2023 |
| Medicare PECOS PAC ID | 8527428333 |
|---|---|
| Medicare Enrollment ID | O20230712000892 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154016178 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| Provider Name | Jonathan R Van Dyke |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1063864270 PECOS PAC ID: 0143503037 Enrollment ID: I20230713000853 |
| Provider Name | Brian Garcia |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1639661432 PECOS PAC ID: 3678933314 Enrollment ID: I20230713001314 |
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