Provider Demographics
NPI:1255051710
Name:CREEKSIDE COMMONS DENTISTRY PLLC
Entity type:Organization
Organization Name:CREEKSIDE COMMONS DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DARWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-569-2456
Mailing Address - Street 1:3912 S WADSWORTH BLVD APT 310
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2269
Mailing Address - Country:US
Mailing Address - Phone:909-569-2456
Mailing Address - Fax:
Practice Address - Street 1:6920 E 128TH AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602
Practice Address - Country:US
Practice Address - Phone:909-569-2456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-02
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental