Provider Demographics
NPI:1295974780
Name:CREATIVE DENTAL
Entity type:Organization
Organization Name:CREATIVE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:LUU
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-641-0481
Mailing Address - Street 1:2585 S NELLIS BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-7548
Mailing Address - Country:US
Mailing Address - Phone:702-641-0481
Mailing Address - Fax:702-641-0128
Practice Address - Street 1:2585 S NELLIS BLVD STE 6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-7548
Practice Address - Country:US
Practice Address - Phone:702-641-0481
Practice Address - Fax:702-641-0128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4585122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty