# CREEKSIDE DENTAL ELLENSBURG PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275862468
- **Authorized official:** MRS. LESLEE R THYSELL (TEMP OFC MGR)
- **Authorized official phone:** (509) 577-8279

## Contact information

- **Practice address:** 2601 TRIPLE L LOOP, ELLENSBURG, WA 98926
- **Practice address phone:** (509) 933-4800
- **Mailing address:** 2601 TRIPLE L LOOP, ELLENSBURG, WA 98926
- **Mailing address phone:** (509) 933-4800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 7703 | WA | Yes |

## Other

- **Enumeration date:** 12/17/2009
- **Last updated:** 12/17/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | NONE YET | — | WA |