Provider Demographics
NPI:1891827341
Name:TREESE, CLAIR DALE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLAIR
Middle Name:DALE
Last Name:TREESE
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 1:620 N HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-1612
Mailing Address - Country:US
Mailing Address - Phone:717-367-9144
Mailing Address - Fax:
Practice Address - Street 1:620 N HANOVER ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-1612
Practice Address - Country:US
Practice Address - Phone:717-367-9144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021461L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice