Organization
COOPER CREEK DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHELLY DONEGAN MCAVOY DME (PRESIDENT)
(941) 366-1010
Entity
Organization
Contact information
Practice address
8460 COOPER CREEK BLVD, SUITE 103, UNIVERSITY PARK, FL 34201-2019
(941) 366-1010
(941) 355-5558
Mailing address
8460 COOPER CREEK BLVD, SUITE 103, UNIVERSITY PARK, FL 34201-2019
(941) 366-1010
(941) 355-5558
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN16321
FL
122300000X
Dentist
DN16999
FL
Other
Enumeration date
10/30/2014
Last updated
10/30/2014
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