Provider Demographics
NPI:1184830788
Name:CRESSMAN DENTAL GROUP, PC
Entity Type:Organization
Organization Name:CRESSMAN DENTAL GROUP, PC
Other - Org Name:GENTLE DENTAL GREEN VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PC OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:H
Authorized Official - Last Name:CRESSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:800-684-6440
Mailing Address - Street 1:9800 S LA CIENEGA BLVD
Mailing Address - Street 2:STE 899, ROOM 4
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4440
Mailing Address - Country:US
Mailing Address - Phone:800-684-6440
Mailing Address - Fax:877-725-7443
Practice Address - Street 1:653 N STEPHANIE ST
Practice Address - Street 2:C3
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2634
Practice Address - Country:US
Practice Address - Phone:702-435-3827
Practice Address - Fax:702-435-3973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3516122300000X
NV6427122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty