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General NPI Number Information
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NPI Number | 1255051710
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Entity Type | Organization
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Legal Business Name | CREEKSIDE COMMONS DENTISTRY PLLC
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Dates
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Enumeration Date | 09/02/2022
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Last Update Date | 09/05/2022
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Provider Practice Location Address
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Address Line | 6920 E 128TH AVE SUITE 160
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City | THORNTON
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State | CO
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Zip | 80602
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Country | US
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Telephone | 909-569-2456
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Fax |
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Provider Business Mailing Address
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Address Line | 3912 S WADSWORTH BLVD APT 310
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City | LAKEWOOD
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State | CO
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Zip | 80235-2269
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Country | US
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Telephone | 909-569-2456
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DARWIN FERNG
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Credential |
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Telephone | 909-569-2456
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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 |
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License Number State |
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