Provider Demographics
NPI:1457990566
Name:VENICE DENTAL CARE, PA
Entity Type:Organization
Organization Name:VENICE DENTAL CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:J
Authorized Official - Last Name:ECK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-777-4866
Mailing Address - Street 1:1515 TAMIAMI TRL S STE 3
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-5557
Mailing Address - Country:US
Mailing Address - Phone:941-497-1585
Mailing Address - Fax:
Practice Address - Street 1:1515 TAMIAMI TRL S STE 3
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-5557
Practice Address - Country:US
Practice Address - Phone:941-497-1585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty