Healthcare Provider Details

I. General information

NPI: 1881579886
Provider Name (Legal Business Name): BLUFFTON FAMILY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BUCK ISLAND RD
BLUFFTON SC
29910-5936
US

IV. Provider business mailing address

400 RIVERWALK TER STE 259
JENKS OK
74037-5619
US

V. Phone/Fax

Practice location:
  • Phone: 918-998-0096
  • 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: OWNER/DENTIST
Credential: DDS
Phone: 918-998-0996