Provider Demographics
NPI:1851593669
Name:CREATIVE DENTAL SOLUTIONS LLC, P.A.
Entity Type:Organization
Organization Name:CREATIVE DENTAL SOLUTIONS LLC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:SEVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-942-3000
Mailing Address - Street 1:1407 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2403
Mailing Address - Country:US
Mailing Address - Phone:207-942-3000
Mailing Address - Fax:207-992-4054
Practice Address - Street 1:1407 BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2403
Practice Address - Country:US
Practice Address - Phone:207-942-3000
Practice Address - Fax:207-992-4054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3269261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental