Provider Demographics
NPI:1881814747
Name:CREAGHE, RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:CREAGHE
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 1:1099 D ST
Mailing Address - Street 2:SUITE #206
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2829
Mailing Address - Country:US
Mailing Address - Phone:415-453-0744
Mailing Address - Fax:415-453-5554
Practice Address - Street 1:1099 D ST
Practice Address - Street 2:SUITE #206
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2829
Practice Address - Country:US
Practice Address - Phone:415-453-0744
Practice Address - Fax:415-453-5554
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35704122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist