| Bonita Dental Care, Pa | |
|
8951 Bonita Beach Rd Se Suite 206 Bonita Springs FL 34135-4201 | |
| (239) 992-8555 | |
| (239) 992-8644 |
| Full Name | Bonita Dental Care, Pa |
|---|---|
| Speciality | Dentist |
| Location | 8951 Bonita Beach Rd Se, Bonita Springs, Florida |
| Authorized Official Name and Position | Frederick Joseph Eck (OWNER) |
| Authorized Official Contact | 2397778664 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bonita Dental Care, Pa 8951 Bonita Beach Rd Se Suite 206 Bonita Springs FL 34135-4201 Ph: (239) 992-8555 | Bonita Dental Care, Pa 8951 Bonita Beach Rd Se Suite 206 Bonita Springs FL 34135-4201 Ph: (239) 992-8555 |
| NPI Number | 1508101726 |
|---|---|
| Provider Enumeration Date | 11/28/2012 |
| Last Update Date | 06/25/2014 |
| Medicare PECOS PAC ID | 3173948635 |
|---|---|
| Medicare Enrollment ID | O20200731001328 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508101726 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN15395 (Florida) | Primary |
| Provider Name | Fredereck J Eck |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1275750473 PECOS PAC ID: 2466765151 Enrollment ID: I20200731001563 |
| Provider Name | Alijah Bradley |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1003224148 PECOS PAC ID: 7911322375 Enrollment ID: I20200731001732 |
| Provider Name | Dominick Catania |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1275764029 PECOS PAC ID: 4183933989 Enrollment ID: I20200731002155 |
| Provider Name | Matthew Keller |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1356990097 PECOS PAC ID: 7012333743 Enrollment ID: I20200812002021 |
| Provider Name | Rodion Dmd Pinkhasov |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1831758416 PECOS PAC ID: 1355743915 Enrollment ID: I20210706002230 |
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