Provider Demographics
NPI:1982827002
Name:KREDICH, GEORGE W (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:W
Last Name:KREDICH
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 1:600A OLD TROLLEY RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5657
Mailing Address - Country:US
Mailing Address - Phone:843-871-2971
Mailing Address - Fax:843-871-7412
Practice Address - Street 1:600A OLD TROLLEY RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5657
Practice Address - Country:US
Practice Address - Phone:843-871-2971
Practice Address - Fax:843-871-7412
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice