Provider Demographics
NPI:1780011221
Name:SPRING CREEK DENTAL PLLC
Entity Type:Organization
Organization Name:SPRING CREEK DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:KAINES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-482-8883
Mailing Address - Street 1:2001 S SHIELDS ST
Mailing Address - Street 2:BLDG C1
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1827
Mailing Address - Country:US
Mailing Address - Phone:970-482-8883
Mailing Address - Fax:970-484-9278
Practice Address - Street 1:2001 SOUTH SHIELDS STREET
Practice Address - Street 2:BLDG. C-1
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526
Practice Address - Country:US
Practice Address - Phone:970-482-8883
Practice Address - Fax:970-484-9278
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCHAEFER & KAINES FAMILY DENTISTRY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-30
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty