| Creative Smiles Family Dentistry | |
|
608 S Trenton St Rutherford TN 38369-9715 | |
| (731) 665-7240 | |
| (731) 665-7268 |
| Full Name | Creative Smiles Family Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 608 S Trenton St, Rutherford, Tennessee |
| Authorized Official Name and Position | Warren Fred Stovall (DENTIST/ OWNER) |
| Authorized Official Contact | 7316657240 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Creative Smiles Family Dentistry Po Box 38 608 S. Trenton St Rutherford TN 38369-0038 Ph: (731) 665-7240 | Creative Smiles Family Dentistry 608 S Trenton St Rutherford TN 38369-9715 Ph: (731) 665-7240 |
| NPI Number | 1013190149 |
|---|---|
| Provider Enumeration Date | 12/12/2007 |
| Last Update Date | 12/12/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013190149 | NPI | - | NPPES |
| 9181903 | Other | TN | DORAL DENTAL |
| 3130925 | Other | TN | BLUE CROSS BLUE SHIELD |
| 5440713 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 7612 (Tennessee) | Primary |