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General NPI Number Information
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NPI Number | 1710222872
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Entity Type | Organization
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Legal Business Name | CREATIVE SMILES INC
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Dates
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Enumeration Date | 11/30/2012
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Last Update Date | 11/30/2012
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Provider Practice Location Address
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Address Line | 3600 OLENTANGY RIVER RD SUITE #483-A
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City | COLUMBUS
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State | OH
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Zip | 43214-3437
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Country | US
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Telephone | 614-459-7766
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Fax | 614-459-0171
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Provider Business Mailing Address
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Address Line | 3600 OLENTANGY RIVER RD SUITE #483-A
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City | COLUMBUS
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State | OH
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Zip | 43214-3437
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Country | US
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Telephone | 614-459-7766
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Fax | 614-459-0171
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Authorized Official
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Title or Position | OWNER
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Name | ERIC BUCK
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Credential | DDS
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Telephone | 614-459-7766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30021908
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License Number State | OH
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