Modern Dental Cape Coral Pllc
NPI #1437785847 in Cape Coral, Florida
Provider Information
- NPI Number
- 1437785847
- Entity Type
- Organization
- Organization Name
- Modern Dental Cape Coral Pllc
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- MODERN DENTAL, LLC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Mar 17, 2020
- Last Updated
- Mar 17, 2020
Practice Location
- Address
- 706 SW PINE ISLAND RD
- Address 2
- SUITE 103
- City
- Cape Coral
- State
- Florida
- ZIP Code
- 33991
- Phone
- (941) 610-6200
Authorized Official
- Name
- TYLER M BLACKENBURG, DMD
- Title
- PERIODONTIST
- Phone
- (954) 736-7924
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - Periodontics — Periodontics |
| Dentist - General Practice — General Practice |
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