Provider Demographics
NPI:1992359541
Name:SF CREEKSIDE DENTAL
Entity Type:Organization
Organization Name:SF CREEKSIDE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:EREKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:385-448-1500
Mailing Address - Street 1:743 E 700 N
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1699
Mailing Address - Country:US
Mailing Address - Phone:385-448-1500
Mailing Address - Fax:
Practice Address - Street 1:743 E 700 N
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1699
Practice Address - Country:US
Practice Address - Phone:385-448-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty