Provider Demographics
NPI:1326368382
Name:SUSAN B CREECH DDS PLLC
Entity Type:Organization
Organization Name:SUSAN B CREECH DDS PLLC
Other - Org Name:COLLINS CREECH AND SHEPHERD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CREECH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-239-7471
Mailing Address - Street 1:4621 FORT HENRY DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2616
Mailing Address - Country:US
Mailing Address - Phone:423-239-7471
Mailing Address - Fax:423-726-2304
Practice Address - Street 1:4621 FORT HENRY DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-2616
Practice Address - Country:US
Practice Address - Phone:423-239-7471
Practice Address - Fax:423-726-2304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS000082781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty