Provider Demographics
NPI:1023481736
Name:CREEKSIDE FAMILY DENTAL
Entity type:Organization
Organization Name:CREEKSIDE FAMILY DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:LEFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-471-5090
Mailing Address - Street 1:111 W JOHNSTOWN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3515
Mailing Address - Country:US
Mailing Address - Phone:614-471-5090
Mailing Address - Fax:614-471-5277
Practice Address - Street 1:111 W JOHNSTOWN RD
Practice Address - Street 2:SUITE A
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3515
Practice Address - Country:US
Practice Address - Phone:614-471-5090
Practice Address - Fax:614-471-5277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0234801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty