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General NPI Number Information
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NPI Number | 1649540774
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Entity Type | Organization
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Legal Business Name | CYNTHIA B. CREECH, DDS, DENTAL CORP
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Dates
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Enumeration Date | 01/05/2012
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Last Update Date | 01/05/2012
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Provider Practice Location Address
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Address Line | 231 MAIN ST
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City | BEN LOMOND
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State | CA
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Zip | 95005-9394
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Country | US
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Telephone | 831-336-2261
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Fax | 831-336-5600
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Provider Business Mailing Address
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Address Line | PO BOX 847
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City | BEN LOMOND
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State | CA
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Zip | 95005-0847
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Country | US
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Telephone | 831-336-2261
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Fax | 831-336-5600
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. CYNTHIA CREECH
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Credential | DDS
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Telephone | 831-336-2261
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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 | 51551
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License Number State | CA
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