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General NPI Number Information
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NPI Number | 1144608282
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Entity Type | Organization
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Legal Business Name | CREEKSIDE ENDODONTICS, LLC
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Dates
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Enumeration Date | 05/08/2015
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Last Update Date | 05/08/2015
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Provider Practice Location Address
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Address Line | 10450 PARK MEADOWS DR SUITE 306
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City | LONE TREE
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State | CO
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Zip | 80124-5529
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Country | US
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Telephone | 303-524-9343
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Fax |
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Provider Business Mailing Address
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Address Line | 10450 PARK MEADOWS DR SUITE 306
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City | LONE TREE
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State | CO
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Zip | 80124-5529
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Country | US
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Telephone | 303-524-9343
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Fax |
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Authorized Official
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Title or Position | )WNER
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Name | ANDREW RICHARD STUBBS
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Credential | DMD
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Telephone | 303-594-4621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DEN10252
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License Number State | CO
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