Provider Demographics
NPI:1508101726
Name:BONITA DENTAL CARE, PA
Entity Type:Organization
Organization Name:BONITA 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 1:8951 BONITA BEACH RD SE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4201
Mailing Address - Country:US
Mailing Address - Phone:239-992-8555
Mailing Address - Fax:239-992-8644
Practice Address - Street 1:8951 BONITA BEACH RD SE
Practice Address - Street 2:SUITE 206
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4201
Practice Address - Country:US
Practice Address - Phone:239-992-8555
Practice Address - Fax:239-992-8644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
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