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General NPI Number Information
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NPI Number | 1023963022
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Entity Type | Organization
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Legal Business Name | SILVER LAKE DENTAL PA
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Dates
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Enumeration Date | 03/04/2026
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 400 CIRCLE DR
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City | SILVER LAKE
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State | KS
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Zip | 66539-9522
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Country | US
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Telephone | 785-582-0185
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Fax |
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Provider Business Mailing Address
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Address Line | 400 RIVERWALK TER STE 250
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City | JENKS
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State | OK
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Zip | 74037-5619
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Country | US
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Telephone | 918-998-0996
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Fax | 918-235-9079
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Authorized Official
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Title or Position | DENTIST
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Name | CREED CARDON
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Credential | DDS
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Telephone | 918-998-0996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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