Provider Demographics
NPI:1063565364
Name:CREZNIC, JAMES H (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:CREZNIC
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-1928
Mailing Address - Country:US
Mailing Address - Phone:207-778-6342
Mailing Address - Fax:207-778-6527
Practice Address - Street 1:122 HIGH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-1928
Practice Address - Country:US
Practice Address - Phone:207-778-6342
Practice Address - Fax:207-778-6527
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME35961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice