Provider Demographics
NPI:1538527114
Name:CREEKSIDE DENTAL SLEEP THERAPY PLLC
Entity type:Organization
Organization Name:CREEKSIDE DENTAL SLEEP THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:OBSTAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-737-1327
Mailing Address - Street 1:216 N EDISON ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1956
Mailing Address - Country:US
Mailing Address - Phone:509-737-0327
Mailing Address - Fax:509-737-1360
Practice Address - Street 1:216 N EDISON ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1956
Practice Address - Country:US
Practice Address - Phone:509-737-0327
Practice Address - Fax:509-737-1360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010269122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty