| Creek Street Dental | |
|
101 W Creek St Fredericksburg TX 78624-3730 | |
| (830) 990-1178 | |
| (830) 990-2338 |
| Full Name | Creek Street Dental |
|---|---|
| Speciality | Dentist |
| Location | 101 W Creek St, Fredericksburg, Texas |
| Authorized Official Name and Position | Edwin Fred Grimes (OWNER) |
| Authorized Official Contact | 8309901178 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Creek Street Dental 101 W Creek St Fredericksburg TX 78624-3730 Ph: (830) 990-1178 | Creek Street Dental 101 W Creek St Fredericksburg TX 78624-3730 Ph: (830) 990-1178 |
| NPI Number | 1487925848 |
|---|---|
| Provider Enumeration Date | 01/17/2012 |
| Last Update Date | 01/17/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487925848 | NPI | - | NPPES |
| 009594501 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 8430 (Texas) | Primary |
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Yvonne Randall, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 205 W Windcrest St Ste 330, Fredericksburg, TX 78624 Phone: 830-990-9660 | |
Ericka T Mcbrine Dds Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 101 W Creek St, Fredericksburg, TX 78624 Phone: 830-990-1178 Fax: 830-990-2338 |