Provider Demographics
NPI:1912687450
Name:CREIGHTON, CORAL ESTHER STROMG (DMD)
Entity Type:Individual
Prefix:
First Name:CORAL
Middle Name:ESTHER STROMG
Last Name:CREIGHTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:CORAL
Other - Middle Name:ESTHER
Other - Last Name:STROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3950 GOODPASTURE LOOP APT P262
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-1495
Mailing Address - Country:US
Mailing Address - Phone:406-697-2846
Mailing Address - Fax:
Practice Address - Street 1:1740 W 17TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3619
Practice Address - Country:US
Practice Address - Phone:458-228-3271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11852122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist