Provider Demographics
NPI:1235735218
Name:CREEKWOOD DENTAL ARTS, PLLC
Entity Type:Organization
Organization Name:CREEKWOOD DENTAL ARTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:REVVIE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:254-772-3632
Mailing Address - Street 1:7911 WOODWAY DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3866
Mailing Address - Country:US
Mailing Address - Phone:254-772-3632
Mailing Address - Fax:254-772-7856
Practice Address - Street 1:7911 WOODWAY DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3866
Practice Address - Country:US
Practice Address - Phone:254-772-3632
Practice Address - Fax:254-772-7856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental