Organization
CRE8TIVE PEDIATRIC DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSICA MARSHALL DDS (PEDIATRIC DENTIST/OWNER)
(972) 544-7524
Entity
Organization
Contact information
Practice address
2201 FORT WORTH AVENUE, DALLAS, TX 75211
(972) 544-7524
Mailing address
2787 N HOUSTON ST APT 4002, DALLAS, TX 75219-5042
(281) 935-8668
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841425394
—
TX
Enumeration date
02/13/2020
Last updated
02/13/2020
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