Provider Demographics
NPI:1326062506
Name:CREEKMORE, RUFUS C (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUFUS
Middle Name:C
Last Name:CREEKMORE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6133 SHADY SIDE RD.
Mailing Address - Street 2:P.O. BOX 428
Mailing Address - City:SHADY SIDE
Mailing Address - State:MD
Mailing Address - Zip Code:20764
Mailing Address - Country:US
Mailing Address - Phone:410-867-0247
Mailing Address - Fax:410-867-0248
Practice Address - Street 1:6133 SHADY SIDE RD.
Practice Address - Street 2:
Practice Address - City:SHADY SIDE
Practice Address - State:MD
Practice Address - Zip Code:20764
Practice Address - Country:US
Practice Address - Phone:410-867-0247
Practice Address - Fax:410-867-0248
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD94171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice