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General NPI Number Information
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NPI Number | 1093950446
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Entity Type | Organization
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Legal Business Name | CHERRY CREEK DENTAL GROUP P.C.
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Dates
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Enumeration Date | 12/12/2008
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 5700 MANCHACA RD SUITE 340
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City | AUSTIN
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State | TX
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Zip | 78745-3679
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Country | US
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Telephone | 512-448-9655
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Fax | 512-448-9668
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Provider Business Mailing Address
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Address Line | 5700 MANCHACA RD SUITE 340
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City | AUSTIN
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State | TX
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Zip | 78745-3679
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Country | US
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Telephone | 512-448-9655
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Fax | 512-448-9668
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | MIHAELA ATANASIU
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Credential |
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Telephone | 773-746-2368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 28848
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License Number State | TX
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