Provider Demographics
NPI:1053857508
Name:SILVER CREEK DENTISTRY LLC
Entity type:Organization
Organization Name:SILVER CREEK DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-748-7200
Mailing Address - Street 1:1209 W FOND DU LAC ST
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-9289
Mailing Address - Country:US
Mailing Address - Phone:920-748-7200
Mailing Address - Fax:920-748-7435
Practice Address - Street 1:1209 W FOND DU LAC ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-9289
Practice Address - Country:US
Practice Address - Phone:920-748-7200
Practice Address - Fax:920-748-7435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty