=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427263276
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICK C. CREEVAN D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2007
-----------------------------------------------------
Last Update Date | 04/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1964 FOURTH STREET
-----------------------------------------------------
City | LIVERMORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94550-4163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-443-5980
-----------------------------------------------------
Fax | 925-294-9083
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1964 FOURTH STREET
-----------------------------------------------------
City | LIVERMORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94550-4163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-443-5980
-----------------------------------------------------
Fax | 925-294-9083
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 47706
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------