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General NPI Number Information
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NPI Number | 1174776850
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Entity Type | Organization
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Legal Business Name | CREATIVE DENTISTS, INC
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 32700 ALVARADO BLVD
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City | FREMONT
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State | CA
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Zip | 94555-1202
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Country | US
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Telephone | 510-477-0811
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Fax | 510-477-0541
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Provider Business Mailing Address
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Address Line | 32700 ALVARADO BLVD
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City | FREMONT
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State | CA
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Zip | 94555-1202
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Country | US
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Telephone | 510-477-0811
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Fax | 510-477-0541
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Authorized Official
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Title or Position | CEO
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Name | PAUL NGUYEN
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Credential | DDS
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Telephone | 510-477-0811
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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 | 44228
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License Number State | CA
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