| Cooper Creek Dental, Llc | |
|
8460 Cooper Creek Blvd Suite 103 University Park FL 34201-2019 | |
| (941) 366-1010 | |
| (941) 355-5558 |
| Full Name | Cooper Creek Dental, Llc |
|---|---|
| Speciality | Dentist |
| Location | 8460 Cooper Creek Blvd, University Park, Florida |
| Authorized Official Name and Position | Shelly Donegan Mcavoy (PRESIDENT) |
| Authorized Official Contact | 9413661010 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cooper Creek Dental, Llc 8460 Cooper Creek Blvd Suite 103 University Park FL 34201-2019 Ph: (941) 366-1010 | Cooper Creek Dental, Llc 8460 Cooper Creek Blvd Suite 103 University Park FL 34201-2019 Ph: (941) 366-1010 |
| NPI Number | 1679978894 |
|---|---|
| Provider Enumeration Date | 10/30/2014 |
| Last Update Date | 10/30/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679978894 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN16321 (Florida) | Primary |
| 122300000X | Dentist | DN16999 (Florida) | Secondary |
Aspen Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 5231 University Pkwy Unit 120, University Park, FL 34201 Phone: 941-363-0458 Fax: 941-351-5827 |