=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689103038
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CREIGHTON DESHAWN POWELL DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2017
-----------------------------------------------------
Last Update Date | 09/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 143 TRAFALGAR ST SW
-----------------------------------------------------
City | AIKEN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29801-3760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-641-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 RIVER PLACE DR UNIT 511
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30909-0062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-940-5502
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 10335
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------