Provider Demographics
NPI:1144608282
Name:CREEKSIDE ENDODONTICS, LLC
Entity Type:Organization
Organization Name:CREEKSIDE ENDODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:)WNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:STUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-594-4621
Mailing Address - Street 1:10450 PARK MEADOWS DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5529
Mailing Address - Country:US
Mailing Address - Phone:303-524-9343
Mailing Address - Fax:
Practice Address - Street 1:10450 PARK MEADOWS DR
Practice Address - Street 2:SUITE 306
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5529
Practice Address - Country:US
Practice Address - Phone:303-524-9343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN10252261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1710963343OtherANDREW STUBBS NPI NUMBER
CODEN10252OtherCOLORADO DENTAL LICENSE