Provider Demographics
NPI:1558524090
Name:CREEKVIEW DENTAL PC
Entity Type:Organization
Organization Name:CREEKVIEW DENTAL PC
Other - Org Name:CREEKVIEW FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-459-1100
Mailing Address - Street 1:860 HEBRON PKWY STE 902
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-5145
Mailing Address - Country:US
Mailing Address - Phone:972-459-1100
Mailing Address - Fax:
Practice Address - Street 1:860 HEBRON PKWY STE 902
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5145
Practice Address - Country:US
Practice Address - Phone:972-459-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-04
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX188321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty