Healthcare Provider Details

I. General information

NPI: 1598579898
Provider Name (Legal Business Name): CLEAR CREEK DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 NW MYHRE RD STE 201
SILVERDALE WA
98383-7669
US

IV. Provider business mailing address

2430 NW MYHRE RD STE 201
SILVERDALE WA
98383-7669
US

V. Phone/Fax

Practice location:
  • Phone: 360-692-6332
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNY GARCIA-ROCHA
Title or Position: SR CREDENTIALING TEAM LEAD
Credential:
Phone: 972-869-3789