Provider Demographics
NPI:1356182166
Name:CREATIVE SMILES PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:CREATIVE SMILES PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEJAY
Authorized Official - Middle Name:PAULINE
Authorized Official - Last Name:ANANABA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-931-4710
Mailing Address - Street 1:790 N PRESTON RD STE 10
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-9840
Mailing Address - Country:US
Mailing Address - Phone:729-984-7345
Mailing Address - Fax:972-984-5227
Practice Address - Street 1:790 N PRESTON RD STE 10
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-9840
Practice Address - Country:US
Practice Address - Phone:972-984-7345
Practice Address - Fax:972-984-5227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty