MEDICARE: CREATIVE DENTISTS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	44228	CA

General Provider Information

NPI Number	:	1174776850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE DENTISTS, INC

Provider Business Mailing Address
First Line	:	32700 ALVARADO BLVD
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94555-1202
Country	:	US
Telephone Number	:	510-477-0811
Fax Number	:	510-477-0541

Provider Business Practice Location Address
First Line	:	32700 ALVARADO BLVD
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94555-1202
Country	:	US
Telephone Number	:	510-477-0811
Fax Number	:	510-477-0541

Authorized Official
Title or Position	:	CEO
Name	:	PAUL NGUYEN
Credential	:	DDS
Telephone Number	:	510-477-0811

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	10/28/2008

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