| Lakes Park Children's Dentistry & Orthodontics | |
|
7117 Congdon Rd Suite 100 Fort Myers FL 33908-4216 | |
| (239) 418-1444 | |
| (239) 418-1888 |
| Full Name | Lakes Park Children's Dentistry & Orthodontics |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 7117 Congdon Rd, Fort Myers, Florida |
| Authorized Official Name and Position | Oliver P Favalli (OWNER/DOCTOR) |
| Authorized Official Contact | 2394181444 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakes Park Children's Dentistry & Orthodontics 7117 Congdon Rd Suite 100 Fort Myers FL 33908-4216 Ph: (239) 418-1444 | Lakes Park Children's Dentistry & Orthodontics 7117 Congdon Rd Suite 100 Fort Myers FL 33908-4216 Ph: (239) 418-1444 |
| NPI Number | 1841625910 |
|---|---|
| Provider Enumeration Date | 09/09/2013 |
| Last Update Date | 09/09/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841625910 | NPI | - | NPPES |
| 070912300 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | DN13738 (Florida) | Primary |
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