# CREEKSIDE DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** McColley Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285982025
- **Authorized official:** DR. JOSEPH ROLLIN MCCOLLEY D.D.S (OWNER/DENTIST)
- **Authorized official phone:** (307) 674-9222

## Contact information

- **Practice address:** 642 VAL VISTA ST, STUITE \#A, SHERIDAN, WY 82801-3659
- **Practice address phone:** (307) 674-9222
- **Practice address fax:** (307) 674-1765
- **Mailing address:** 642 VAL VISTA ST, STUITE \#A, SHERIDAN, WY 82801-3659
- **Mailing address phone:** (307) 674-9222
- **Mailing address fax:** (307) 674-1765

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 08/28/2012
- **Last updated:** 12/31/2014