| Organization Name: | CREATIVE SMILES FAMILY DENTISTRY |
| NPI Number: | 1013190149 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WARREN FRED STOVALL (DENTIST/ OWNER) |
| Mailing Address: | 608 S Trenton St Rutherford |
| State: | TN US |
| Postal Code: | 383699715 |
| Phone Number: | 7316657240 |
| Fax Number: | 7316657268 |
| NPI Enumeration Date: | 12/12/2007 |
| NPI Last Update Date: | 12/12/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 7612 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |