Healthcare Provider Details

I. General information

NPI: 1518970854
Provider Name (Legal Business Name): WARREN LEROY CREED D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

QUARTERMASTER ROAD CHALAN LAULAU
SAIPAN MP
96950-0169
US

IV. Provider business mailing address

PO BOX 500169
SAIPAN MP
96950-0169
US

V. Phone/Fax

Practice location:
  • Phone: 670-234-6323
  • Fax:
Mailing address:
  • Phone: 670-234-6323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number122
License Number StateMP
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3570
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD7705
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: