Provider Demographics
NPI:1306022371
Name:JAMES H. CREZNIC DMD, PA
Entity Type:Organization
Organization Name:JAMES H. CREZNIC DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:CREZNIC
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-778-6342
Mailing Address - Street 1:122 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-1928
Mailing Address - Country:US
Mailing Address - Phone:207-778-6342
Mailing Address - Fax:207-778-6527
Practice Address - Street 1:122 HIGH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-1928
Practice Address - Country:US
Practice Address - Phone:207-778-6342
Practice Address - Fax:207-778-6527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME35961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty