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General NPI Number Information
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NPI Number | 1912071358
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Entity Type | Organization
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Legal Business Name | CREATIVE DENTAL ARTS,LLC
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Dates
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Enumeration Date | 11/18/2006
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Last Update Date | 07/31/2014
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Provider Practice Location Address
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Address Line | 1127 DALEWOOD ST
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City | KINGSTON
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State | NY
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Zip | 12401-1011
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Country | US
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Telephone | 845-336-5114
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Fax |
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Provider Business Mailing Address
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Address Line | 1127 DALEWOOD ST
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City | KINGSTON
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State | NY
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Zip | 12401-1011
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Country | US
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Telephone | 845-336-5114
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. STANLEY WEISS
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Credential | DDS
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Telephone | 845-336-5114
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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 | 026337
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License Number State | NY
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