Provider Demographics
NPI:1568531143
Name:HOUSE, CREIGH SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:CREIGH
Middle Name:SCOTT
Last Name:HOUSE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 S MONROE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204
Mailing Address - Country:US
Mailing Address - Phone:509-838-5597
Mailing Address - Fax:509-838-7195
Practice Address - Street 1:1004 S MONROE
Practice Address - Street 2:SUITE #100
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204
Practice Address - Country:US
Practice Address - Phone:509-838-5597
Practice Address - Fax:509-838-7195
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA56561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5038203Medicaid