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NPI Code Detail

MEDICARE: CREEKSIDE FAMILY DENTAL, P.C.

MEDICARE: CREEKSIDE FAMILY DENTAL, P.C.
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1376493817
Entity Type Code : Organization
Provider Name (Legal Business Name) : CREEKSIDE FAMILY DENTAL, P.C.
Provider Business Mailing Address
First Line : 4020 S 700 E STE 1
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84107-7900
Country : US
Telephone Number : 801-263-2633
Fax Number :
Provider Business Practice Location Address
First Line : 4020 S 700 E STE 1
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84107-7900
Country : US
Telephone Number : 801-263-2633
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : CECILIA SERRATO
Credential : DMD
Telephone Number : 385-259-3880
Provider Enumeration Date : 02/03/2026
Last Update Date : 02/03/2026

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Directions to “CREEKSIDE FAMILY DENTAL, P.C. ” Practice Location

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