1154333995 NPI number — MR. WARD E CREAGER DMD

Table of content: MR. WARD E CREAGER DMD (NPI 1154333995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154333995 NPI number — MR. WARD E CREAGER DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CREAGER
Provider First Name:
WARD
Provider Middle Name:
E
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

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:
1154333995
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1690 N WASHINGTON BLVD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
OGDEN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84404-3457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-782-4233
Provider Business Mailing Address Fax Number:
801-782-1734

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1690 N WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
OGDEN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84404-3457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-782-4233
Provider Business Practice Location Address Fax Number:
801-782-1734
Provider Enumeration Date:
08/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  5656476 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 56564769902001 . This is a "BXBS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 78191 . This is a "PEHP-CHIP" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com