Provider Demographics
NPI:1144009689
Name:CREEDE DENTAL WORKS PLLC
Entity type:Organization
Organization Name:CREEDE DENTAL WORKS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-658-0322
Mailing Address - Street 1:PO BOX 408
Mailing Address - Street 2:
Mailing Address - City:CREEDE
Mailing Address - State:CO
Mailing Address - Zip Code:81130-0408
Mailing Address - Country:US
Mailing Address - Phone:719-658-0322
Mailing Address - Fax:
Practice Address - Street 1:802 RIO GRANDE AVE
Practice Address - Street 2:
Practice Address - City:CREEDE
Practice Address - State:CO
Practice Address - Zip Code:81130-5144
Practice Address - Country:US
Practice Address - Phone:719-658-0322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental