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General NPI Number Information
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NPI Number | 1003950247
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Entity Type | Individual
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Provider Name | ROBERT H CREAGER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1463 KLONDIKE RD SW SUITE A
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City | CONYERS
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State | GA
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Zip | 30094-5103
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Country | US
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Telephone | 770-922-8733
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Fax |
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Provider Business Mailing Address
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Address Line | 1463 KLONDIKE RD SW SUITE A
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City | CONYERS
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State | GA
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Zip | 30094-5103
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Country | US
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Telephone | 770-922-8733
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN009718
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License Number State | GA
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