Provider Demographics
NPI:1528195286
Name:CHRISTIANA CREEK DENTAL CARE
Entity Type:Organization
Organization Name:CHRISTIANA CREEK DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-262-4378
Mailing Address - Street 1:301 W BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-3078
Mailing Address - Country:US
Mailing Address - Phone:574-262-4378
Mailing Address - Fax:574-266-1481
Practice Address - Street 1:301 W BRISTOL ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-3078
Practice Address - Country:US
Practice Address - Phone:574-262-4378
Practice Address - Fax:574-266-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011190A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1528195286OtherNPI