Organization
CREATIVE SMILES FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WARREN FRED STOVALL DDS (DENTIST/ OWNER)
(731) 665-7240
Entity
Organization
Contact information
Practice address
608 S TRENTON ST, RUTHERFORD, TN 38369-9715
(731) 665-7240
(731) 665-7268
Mailing address
PO BOX 38, 608 S. TRENTON ST, RUTHERFORD, TN 38369-0038
(731) 665-7240
(731) 665-7268
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
7612
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3130925
BLUE CROSS BLUE SHIELD
TN
05
—
5440713
—
TN
01
—
9181903
DORAL DENTAL
TN
Enumeration date
12/12/2007
Last updated
12/12/2007
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