MEDICARE: SILVER LAKE DENTAL PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223D0001X	Public Health Dentistry

General Provider Information

NPI Number	:	1023963022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER LAKE DENTAL PA

Provider Business Mailing Address
First Line	:	400 RIVERWALK TER STE 250
Second Line	:
City	:	JENKS
State	:	OK
Zip	:	74037-5619
Country	:	US
Telephone Number	:	918-998-0996
Fax Number	:	918-235-9079

Provider Business Practice Location Address
First Line	:	400 CIRCLE DR
Second Line	:
City	:	SILVER LAKE
State	:	KS
Zip	:	66539-9522
Country	:	US
Telephone Number	:	785-582-0185
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	CREED CARDON
Credential	:	DDS
Telephone Number	:	918-998-0996

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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