Provider Demographics
NPI:1285171447
Name:SPRING DENTAL CUSHING PLLC
Entity type:Organization
Organization Name:SPRING DENTAL CUSHING PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CREED
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-998-0996
Mailing Address - Street 1:400 RIVERWALK TERR., STE 250
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-5619
Mailing Address - Country:US
Mailing Address - Phone:918-998-0996
Mailing Address - Fax:918-235-9079
Practice Address - Street 1:2329 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-2904
Practice Address - Country:US
Practice Address - Phone:918-285-5500
Practice Address - Fax:844-272-1565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200540820EMedicaid