Creekside Dental, Inc.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

CREEKSIDE DENTAL, INC.

Practice address

4904 Timber Ridge Dr Ste 203
Douglasville, GA 30135-1831

Phone

(770) 577-5727

Fax

(770) 577-7542

NPI assigned

Sep 10, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Pamela Deas

Title

Office Manager

Phone

(770) 577-5727

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1725926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1295561983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4904 TIMBER RIDGE DR STE 203",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301351831",
            "telephone_number": "770-577-5727",
            "fax_number": "770-577-7542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4904 TIMBER RIDGE DR STE 203",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301351831",
            "telephone_number": "770-577-5727",
            "fax_number": "770-577-7542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE DENTAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-10",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A",
        "authorized_official_last_name": "DEAS",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "770-577-5727"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annaleigh Craton
• Charles A Craton, MD
• Asada Crawford, RBT
• Laveta Crawford
• Morgan Crawford
• Crew LLC
• Shanessa Crook, LPC
• Crossroads Church of Douglasville
• Roy Ervin Crowe Jr., D.D.S.P.C.
• Jennifer Ann Crumbley-Dodson, PSY.D.

• Dental Clinic/Center in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Dental Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.