Provider Demographics
NPI:1881923654
Name:SPRING CREEK FAMILY DENTISTRY & ORTHODONTICS
Entity type:Organization
Organization Name:SPRING CREEK FAMILY DENTISTRY & ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BERNIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHISHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-832-3232
Mailing Address - Street 1:34 JEFFERSON COURT
Mailing Address - Street 2:
Mailing Address - City:GORDONSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22942
Mailing Address - Country:US
Mailing Address - Phone:540-832-3232
Mailing Address - Fax:
Practice Address - Street 1:34 JEFFERSON COURT
Practice Address - Street 2:
Practice Address - City:GORDONSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22942
Practice Address - Country:US
Practice Address - Phone:540-832-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA040104951223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty