Provider Demographics
NPI:1508029554
Name:CRISER, GAVIN L (DDS, MS)
Entity Type:Individual
Prefix:
First Name:GAVIN
Middle Name:L
Last Name:CRISER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CHEROKEE RD STE B
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5225
Mailing Address - Country:US
Mailing Address - Phone:843-662-3336
Mailing Address - Fax:
Practice Address - Street 1:220 CHEROKEE RD STE B
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5225
Practice Address - Country:US
Practice Address - Phone:843-662-3336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC68991223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics