Provider Demographics
NPI:1639472608
Name:CREECY, RONALD K (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:K
Last Name:CREECY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RONALD
Other - Middle Name:K
Other - Last Name:CREECY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:195 STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-1849
Mailing Address - Country:US
Mailing Address - Phone:856-345-8039
Mailing Address - Fax:
Practice Address - Street 1:5058 CITY LINE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1441
Practice Address - Country:US
Practice Address - Phone:856-345-8039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO28378L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6361404Medicaid