Provider Demographics
NPI:1528432150
Name:DENTISTRY OF CREEKSIDE PARK, PLLC
Entity type:Organization
Organization Name:DENTISTRY OF CREEKSIDE PARK, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-351-2055
Mailing Address - Street 1:26400 KUYKENDAHL RD
Mailing Address - Street 2:SUITE C210
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-2882
Mailing Address - Country:US
Mailing Address - Phone:281-351-2055
Mailing Address - Fax:281-351-2066
Practice Address - Street 1:26400 KUYKENDAHL RD
Practice Address - Street 2:SUITE C210
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-2882
Practice Address - Country:US
Practice Address - Phone:281-351-2055
Practice Address - Fax:281-351-2066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20978261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental