Healthcare Provider Details

I. General information

NPI: 1225443302
Provider Name (Legal Business Name): TREEHOUSE DENTAL CARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8951 BONITA BEACH RD SE STE 220
BONITA SPRINGS FL
34135-4202
US

IV. Provider business mailing address

8951 BONITA BEACH RD SE STE 220
BONITA SPRINGS FL
34135-4202
US

V. Phone/Fax

Practice location:
  • Phone: 239-444-3568
  • Fax: 239-444-3151
Mailing address:
  • Phone: 239-444-3568
  • Fax: 239-444-3151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN15395
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN15395
License Number StateFL

VIII. Authorized Official

Name: DR. FREDERICK JOSEPH ECK
Title or Position: OWNER
Credential: DDS
Phone: 239-777-4866