Provider Demographics
NPI:1447353057
Name:CREATH, CURTIS JANSSEN (DMD MS)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:JANSSEN
Last Name:CREATH
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:1106 C MAIN STREET
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-0269
Mailing Address - Country:US
Mailing Address - Phone:513-831-3434
Mailing Address - Fax:513-965-3412
Practice Address - Street 1:1106 C MAIN STREET
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-0267
Practice Address - Country:US
Practice Address - Phone:513-831-3434
Practice Address - Fax:513-965-3412
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30 0200451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0983253Medicaid