Cooper Creek Dental, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

DN16321 Issued in FL

Legal business name

COOPER CREEK DENTAL, LLC

Practice address

8460 Cooper Creek Blvd
Suite 103
University Park, FL 34201-2019

Phone

(941) 366-1010

Fax

(941) 355-5558

NPI assigned

Oct 30, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Shelly Donegan McAvoy, DME

Title

President

Phone

(941) 366-1010

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1414627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414627200000",
    "number": "1679978894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8460 COOPER CREEK BLVD",
            "address_2": "SUITE 103",
            "city": "UNIVERSITY PARK",
            "state": "FL",
            "postal_code": "342012019",
            "telephone_number": "941-366-1010",
            "fax_number": "941-355-5558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8460 COOPER CREEK BLVD",
            "address_2": "SUITE 103",
            "city": "UNIVERSITY PARK",
            "state": "FL",
            "postal_code": "342012019",
            "telephone_number": "941-366-1010",
            "fax_number": "941-355-5558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOPER CREEK DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-30",
        "last_updated": "2014-10-30",
        "status": "A",
        "authorized_official_last_name": "MCAVOY",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_middle_name": "DONEGAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "941-366-1010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DME"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN16321",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN16999",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Ruane, DC LLC
• Brooklyn Chupp, RBT
• Brook Coblentz
• Adam Phillip Cole, L.M.T.
• Erika Conville
• Evan Cox
• Thomas Crowgey, D.D.S.
• Tieuha Dang, RBT
• Megan Lyn Davis, LMT
• Gesselle Desmoineaux

• Dentist in University Park, FL
• Providers in University Park, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.