Provider Demographics
NPI:1942334651
Name:KINGSWAYDENTALCARE INC.
Entity type:Organization
Organization Name:KINGSWAYDENTALCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTINEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-624-3550
Mailing Address - Street 1:943 S BENEVA RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2476
Mailing Address - Country:US
Mailing Address - Phone:941-957-3703
Mailing Address - Fax:941-955-5270
Practice Address - Street 1:2200 KINGS HWY
Practice Address - Street 2:# 3 - 1
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-5759
Practice Address - Country:US
Practice Address - Phone:941-624-3550
Practice Address - Fax:941-955-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN123561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty