Coral Dental and Denture PA

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

DN 19837 Issued in FL

Legal business name

CORAL DENTAL AND DENTURE PA

Practice address

12711 McGregor Blvd
Fort Myers, FL 33919-4412

Phone

(239) 542-3925

Fax

(239) 210-5903

NPI assigned

Oct 29, 2012

Last updated

Apr 28, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Juan Carlos Castellanos, DDS

Title

President

Phone

(239) 603-5210

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461801600000",
    "number": "1366796450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12711 MCGREGOR BLVD",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339194412",
            "telephone_number": "239-542-3925",
            "fax_number": "239-210-5903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12711 MCGREGOR BLVD",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339194412",
            "telephone_number": "239-542-3925",
            "fax_number": "239-210-5903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORAL DENTAL AND DENTURE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-29",
        "last_updated": "2016-04-28",
        "status": "A",
        "authorized_official_last_name": "CASTELLANOS",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "CARLOS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-603-5210",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "FL",
            "license": "DN 19837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Coral Care Rides LLC
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• Coral Medical Center LLC
• Coram Alternate Site Services, Inc. (Coram CVS/specialty Infusion Services)
• Jean Corbae, M.A.
• Michael A Corbellini, DO

• Dental Clinic/Center in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Dental Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.