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General NPI Number Information
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NPI Number | 1235847898
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Entity Type | Organization
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Legal Business Name | CLEAR CREEK ORTHODONTICS, PLLC
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Dates
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Enumeration Date | 11/11/2022
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Last Update Date | 11/11/2022
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Provider Practice Location Address
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Address Line | 351 N WESLEY DR
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City | LEAGUE CITY
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State | TX
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Zip | 77573-3684
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Country | US
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Telephone | 281-332-8545
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Fax |
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Provider Business Mailing Address
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Address Line | 351 N WESLEY DR
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City | LEAGUE CITY
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State | TX
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Zip | 77573-3684
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Country | US
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Telephone | 281-332-8545
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Fax |
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Authorized Official
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Title or Position | OWNER, ORTHODONTIST
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Name | JENNIFER SILLER
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Credential | DDS, MSD
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Telephone | 409-370-3513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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