Creative Smiles Family Dentistry
Organization Active NPI Dental Clinic/Center · Rutherford, TN
NPI 1013190149 · NPPES record last updated Dec 12, 2007
Key facts
- NPI
- 1013190149
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dental Clinic/Center 261QD0000X
- License
- 7612 (TN)
- Legal business name
- CREATIVE SMILES FAMILY DENTISTRY
- Practice address
- 608 S Trenton St
Rutherford, TN 38369-9715 - Phone
- (731) 665-7240
- Fax
- (731) 665-7268
- NPI assigned
- Dec 12, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Warren Fred Stovall, DDS
- Title
- Dentist/ Owner
- Phone
- (731) 665-7240
National Provider Directory
Locations
608 S Trenton St
Rutherford, TN 38369
Phone (731) 665-6650
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | 7612 | TN | Yes |
Addresses
Primary practice location
608 S Trenton St
Rutherford, TN 38369-9715
Mailing address
PO Box 38
608 S. Trenton St
Rutherford, TN 38369-0038
Phone (731) 665-7240
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9181903 | Other | TN | DORAL DENTAL |
| 3130925 | Other | TN | BLUE CROSS BLUE SHIELD |
| 5440713 | Medicaid | TN |
Other providers in Rutherford, TN
All providers in Rutherford, TN · Dental Clinic/Center in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 12, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.