Provider Demographics
NPI:1295279867
Name:SPRING DENTAL CLAREMORE, PLLC
Entity type:Organization
Organization Name:SPRING DENTAL CLAREMORE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CREED
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:CARDON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:479-790-1951
Mailing Address - Street 1:1222 N FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3147
Mailing Address - Country:US
Mailing Address - Phone:918-895-6568
Mailing Address - Fax:
Practice Address - Street 1:1222 N FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3147
Practice Address - Country:US
Practice Address - Phone:918-895-6568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty