Provider Demographics
NPI:1558512111
Name:CREISHER, SCOTT A (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:CREISHER
Suffix:
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 1:1059 COLUMBIA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3130
Mailing Address - Country:US
Mailing Address - Phone:717-394-2641
Mailing Address - Fax:717-394-3157
Practice Address - Street 1:1059 COLUMBIA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3130
Practice Address - Country:US
Practice Address - Phone:717-394-2641
Practice Address - Fax:717-394-3157
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029455L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice