1720294036 NPI number — TIMOTHY R. CREECH, DDS

Table of content: LESLIE ANNE MOSELEY LPC-INTERN, NCC (NPI 1144732405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720294036 NPI number — TIMOTHY R. CREECH, DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIMOTHY R. CREECH, DDS
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:
Provider Other Organization Name Type Code:
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:
1720294036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
812 N ARENDELL AVE
Provider Second Line Business Mailing Address:
PO BOX 100
Provider Business Mailing Address City Name:
ZEBULON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27597-2306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-269-7411
Provider Business Mailing Address Fax Number:
919-269-7471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
812 N ARENDELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZEBULON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27597-2306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-269-7411
Provider Business Practice Location Address Fax Number:
919-269-7471
Provider Enumeration Date:
05/15/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CREECH
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
919-269-7411

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  6217 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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