Provider Demographics
NPI:1639391725
Name:EAGLE CREEK DENTISTRY, INC.
Entity Type:Organization
Organization Name:EAGLE CREEK DENTISTRY, INC.
Other - Org Name:VALENTINE DENTAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEAGHAN
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-398-4410
Mailing Address - Street 1:12692 TAMIAMI TRL E
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-8431
Mailing Address - Country:US
Mailing Address - Phone:239-417-6453
Mailing Address - Fax:239-775-6628
Practice Address - Street 1:12692 TAMIAMI TRL E
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-8431
Practice Address - Country:US
Practice Address - Phone:239-417-6453
Practice Address - Fax:239-775-6628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty