Healthcare Provider Details

I. General information

NPI: 1396957866
Provider Name (Legal Business Name): CREATIVE DIMENSIONS IN DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20265 LAKE CHABOT RD
CASTRO VALLEY CA
94546-5307
US

IV. Provider business mailing address

20265 LAKE CHABOT RD
CASTRO VALLEY CA
94546-5307
US

V. Phone/Fax

Practice location:
  • Phone: 510-881-8010
  • Fax: 510-538-0120
Mailing address:
  • Phone: 510-881-8010
  • Fax: 510-538-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. GEORGE DAVID MACKENZIE
Title or Position: MANAGER
Credential: DDS
Phone: 510-881-8010