Provider Demographics
NPI:1821545989
Name:SISTER CREEK DENTAL PLLC
Entity type:Organization
Organization Name:SISTER CREEK DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-391-8200
Mailing Address - Street 1:1605 S. HWY 181
Mailing Address - Street 2:
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114
Mailing Address - Country:US
Mailing Address - Phone:830-391-8200
Mailing Address - Fax:830-391-8201
Practice Address - Street 1:1605 US HIGHWAY 181S
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114
Practice Address - Country:US
Practice Address - Phone:830-391-8200
Practice Address - Fax:830-391-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX298451223P0221X
TX317281223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty