Provider Demographics
NPI:1164737524
Name:CREMEANS, RICKY JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:
Last Name:CREMEANS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 HIGHWAY 190 W
Mailing Address - Street 2:SUITE D
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-6023
Mailing Address - Country:US
Mailing Address - Phone:337-463-6545
Mailing Address - Fax:337-460-1966
Practice Address - Street 1:701 WILSON ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:SC
Practice Address - Zip Code:29706-8568
Practice Address - Country:US
Practice Address - Phone:803-581-3555
Practice Address - Fax:803-581-7924
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8098122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist