MEDICARE: SUSAN B CREECH DDS PLLC

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	1223G0001X	General Practice Dentistry	DS00008278	TN

General Provider Information

NPI Number	:	1326368382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN B CREECH DDS PLLC

Provider Business Mailing Address
First Line	:	4621 FORT HENRY DR
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37663-2616
Country	:	US
Telephone Number	:	423-239-7471
Fax Number	:	423-726-2304

Provider Business Practice Location Address
First Line	:	4621 FORT HENRY DR
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37663-2616
Country	:	US
Telephone Number	:	423-239-7471
Fax Number	:	423-726-2304

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SUSAN B. CREECH
Credential	:	DDS
Telephone Number	:	423-239-7471

Provider Enumeration Date	:	06/01/2010
Last Update Date	:	06/01/2010

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