Provider Demographics
NPI:1053656264
Name:MARCO DENTAL CARE, PA
Entity Type:Organization
Organization Name:MARCO DENTAL CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ECK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-777-8664
Mailing Address - Street 1:950 N COLLIER BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-2725
Mailing Address - Country:US
Mailing Address - Phone:239-389-9400
Mailing Address - Fax:239-389-4999
Practice Address - Street 1:950 N COLLIER BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-2725
Practice Address - Country:US
Practice Address - Phone:239-389-9400
Practice Address - Fax:239-389-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15395122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty