Provider Demographics
NPI:1346526654
Name:CREATIVE DENTAL CARE, PA
Entity Type:Organization
Organization Name:CREATIVE DENTAL CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BANKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-232-0400
Mailing Address - Street 1:423 SOUTH AVE W
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1403
Mailing Address - Country:US
Mailing Address - Phone:908-232-0400
Mailing Address - Fax:
Practice Address - Street 1:423 SOUTH AVE W
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1403
Practice Address - Country:US
Practice Address - Phone:908-232-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI19715-01261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental