| Modern Dental Cape Coral Pllc | |
|
706 Sw Pine Island Rd Suite 103 Cape Coral FL 33991 | |
| (941) 610-6200 | |
| Not Available |
| Full Name | Modern Dental Cape Coral Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 706 Sw Pine Island Rd, Cape Coral, Florida |
| Authorized Official Name and Position | Tyler M Blackenburg (PERIODONTIST) |
| Authorized Official Contact | 9547367924 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Dental Cape Coral Pllc 14575 Tamiami Trl Ste A North Port FL 34287-2743 Ph: (941) 888-2362 | Modern Dental Cape Coral Pllc 706 Sw Pine Island Rd Suite 103 Cape Coral FL 33991 Ph: (941) 610-6200 |
| NPI Number | 1437785847 |
|---|---|
| Provider Enumeration Date | 03/17/2020 |
| Last Update Date | 03/17/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437785847 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| 1223P0300X | Dentist - Periodontics | (* (Not Available)) | Secondary |
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