Provider Demographics
NPI:1922464924
Name:CAYO COSTA DENTAL, INC
Entity type:Organization
Organization Name:CAYO COSTA DENTAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:FOX
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-575-1446
Mailing Address - Street 1:316 W HELEN AVE
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-5501
Mailing Address - Country:US
Mailing Address - Phone:941-575-1446
Mailing Address - Fax:941-637-1963
Practice Address - Street 1:316 W HELEN AVE
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-5501
Practice Address - Country:US
Practice Address - Phone:941-575-1446
Practice Address - Fax:941-637-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental