Creekside Dental, LLC.

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

CREEKSIDE DENTAL, LLC.

Practice address

414 Capitol TRL
Newark, DE 19711-3865

Phone

(302) 738-5766

NPI assigned

Jan 13, 2023

Last updated

Jan 13, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Kellie Jean Cernobyl

Title

Chief Operating Officer

Phone

(302) 392-2460

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1673568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673568000000",
    "number": "1396459376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 PEOPLES PLZ",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197025701",
            "telephone_number": "302-392-2460",
            "fax_number": "302-392-2499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 CAPITOL TRL",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197113865",
            "telephone_number": "302-738-5766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE DENTAL, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-13",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-13",
        "status": "A",
        "authorized_official_last_name": "CERNOBYL",
        "authorized_official_first_name": "KELLIE",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "302-392-2460",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Newark, DE
• Providers in Newark, DE by specialty
• Dentist in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2023; 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.