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General NPI Number Information
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NPI Number | 1639391725
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Entity Type | Organization
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Legal Business Name | EAGLE CREEK DENTISTRY, INC.
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 12692 TAMIAMI TRL E
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City | NAPLES
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State | FL
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Zip | 34113-8431
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Country | US
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Telephone | 239-417-6453
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Fax | 239-775-6628
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Provider Business Mailing Address
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Address Line | 12692 TAMIAMI TRL E
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City | NAPLES
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State | FL
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Zip | 34113-8431
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Country | US
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Telephone | 239-417-6453
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Fax | 239-775-6628
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MEAGHAN DANIELLE VALENTINE
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Credential |
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Telephone | 239-398-4410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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