Provider Demographics
NPI:1093950446
Name:CHERRY CREEK DENTAL GROUP P.C.
Entity Type:Organization
Organization Name:CHERRY CREEK DENTAL GROUP P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIHAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATANASIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-746-2368
Mailing Address - Street 1:5700 MANCHACA RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3679
Mailing Address - Country:US
Mailing Address - Phone:512-448-9655
Mailing Address - Fax:512-448-9668
Practice Address - Street 1:5700 MANCHACA RD
Practice Address - Street 2:SUITE 340
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3679
Practice Address - Country:US
Practice Address - Phone:512-448-9655
Practice Address - Fax:512-448-9668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX288481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty