1184830788 NPI number — CRESSMAN DENTAL GROUP, PC

Table of content: (NPI 1184830788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184830788 NPI number — CRESSMAN DENTAL GROUP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRESSMAN DENTAL GROUP, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GENTLE DENTAL GREEN VALLEY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184830788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9800 S LA CIENEGA BLVD
Provider Second Line Business Mailing Address:
STE 899, ROOM 4
Provider Business Mailing Address City Name:
INGLEWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90301-4440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-684-6440
Provider Business Mailing Address Fax Number:
877-725-7443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
653 N STEPHANIE ST
Provider Second Line Business Practice Location Address:
C3
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89014-2634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-435-3827
Provider Business Practice Location Address Fax Number:
702-435-3973
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CRESSMAN
Authorized Official First Name:
TODD
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PC OWNER/PRESIDENT
Authorized Official Telephone Number:
800-684-6440

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  3516 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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