Provider Demographics
NPI:1396948782
Name:KREISCHER, MARJORY KIZER
Entity type:Individual
Prefix:MRS
First Name:MARJORY
Middle Name:KIZER
Last Name:KREISCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PROGRESS PLAZA
Mailing Address - Street 2:SUITE # 6
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848
Mailing Address - Country:US
Mailing Address - Phone:570-265-2069
Mailing Address - Fax:570-265-8941
Practice Address - Street 1:1 PROGRESS PLAZA
Practice Address - Street 2:BRADFORD COUNTY DENTAL HEALTH SERVICES INC SUITE # 6
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848
Practice Address - Country:US
Practice Address - Phone:570-265-2069
Practice Address - Fax:570-265-8941
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH003278L124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist