Provider Demographics
NPI:1912496159
Name:IMELDA CREWS, DDS, P.C.
Entity Type:Organization
Organization Name:IMELDA CREWS, DDS, P.C.
Other - Org Name:INSPIRATIONAL SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IMELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:678-341-9101
Mailing Address - Street 1:9175 FOUR MILE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-3995
Mailing Address - Country:US
Mailing Address - Phone:770-634-6227
Mailing Address - Fax:
Practice Address - Street 1:202 TRIBBLE GAP RD STE 101
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2540
Practice Address - Country:US
Practice Address - Phone:678-341-9101
Practice Address - Fax:678-771-8925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental