Provider Demographics
NPI:1386799534
Name:SUNCOAST DENTAL CENTER
Entity type:Organization
Organization Name:SUNCOAST DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOODLET
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:239-566-2255
Mailing Address - Street 1:13040 LIVINGSTON ROAD SUITE 3
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105
Mailing Address - Country:US
Mailing Address - Phone:239-566-2255
Mailing Address - Fax:239-566-1788
Practice Address - Street 1:13040 LIVINGSTON RD SUITE 3
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105
Practice Address - Country:US
Practice Address - Phone:239-566-2255
Practice Address - Fax:239-566-1788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty