Provider Demographics
NPI:1659621548
Name:CREMEANS FAMILY DENTISTRY
Entity Type:Organization
Organization Name:CREMEANS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CREMEANS
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-581-3555
Mailing Address - Street 1:186 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:SC
Mailing Address - Zip Code:29706-2918
Mailing Address - Country:US
Mailing Address - Phone:803-581-3555
Mailing Address - Fax:804-581-7924
Practice Address - Street 1:186 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:SC
Practice Address - Zip Code:29706-2918
Practice Address - Country:US
Practice Address - Phone:803-581-3555
Practice Address - Fax:804-581-7924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty