Provider Demographics
NPI:1992857650
Name:CHOW, CREIGHTON STUART (DDS)
Entity type:Individual
Prefix:
First Name:CREIGHTON
Middle Name:STUART
Last Name:CHOW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 TRABUCO RD STE 110
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3617
Mailing Address - Country:US
Mailing Address - Phone:949-559-1178
Mailing Address - Fax:949-559-1179
Practice Address - Street 1:4200 TRABUCO RD STE 110
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3617
Practice Address - Country:US
Practice Address - Phone:949-559-1178
Practice Address - Fax:949-559-1179
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA256891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice