Healthcare Provider Details

I. General information

NPI: 1023963022
Provider Name (Legal Business Name): SILVER LAKE DENTAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CIRCLE DR
SILVER LAKE KS
66539-9522
US

IV. Provider business mailing address

400 RIVERWALK TER STE 250
JENKS OK
74037-5619
US

V. Phone/Fax

Practice location:
  • Phone: 785-582-0185
  • Fax:
Mailing address:
  • Phone: 918-998-0996
  • Fax: 918-235-9079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CREED CARDON
Title or Position: DENTIST
Credential: DDS
Phone: 918-998-0996