Provider Demographics
NPI:1841410792
Name:KREYCIK, W SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:W
Middle Name:SCOTT
Last Name:KREYCIK
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 1:1843 MADORA AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-3059
Mailing Address - Country:US
Mailing Address - Phone:307-358-9625
Mailing Address - Fax:307-358-0578
Practice Address - Street 1:1843 MADORA AVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:WY
Practice Address - Zip Code:82633-3059
Practice Address - Country:US
Practice Address - Phone:307-358-9625
Practice Address - Fax:307-358-0578
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY9421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice