Provider Demographics
NPI:1780342733
Name:FRIENDLY DENTAL PA
Entity type:Organization
Organization Name:FRIENDLY DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-529-4159
Mailing Address - Street 1:16520 S TAMIAMI TRL STE 106
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-5319
Mailing Address - Country:US
Mailing Address - Phone:239-529-4159
Mailing Address - Fax:
Practice Address - Street 1:23100 VIA VILLAGIO
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-8301
Practice Address - Country:US
Practice Address - Phone:239-529-4159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty