Provider Demographics
NPI:1194705624
Name:CREASY, JOSEPH EDWARD JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:CREASY
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1429 CLEAR LAKE RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5895
Mailing Address - Country:US
Mailing Address - Phone:817-599-4839
Mailing Address - Fax:817-594-5206
Practice Address - Street 1:1429 CLEAR LAKE RD
Practice Address - Street 2:SUITE 600
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5895
Practice Address - Country:US
Practice Address - Phone:817-599-4839
Practice Address - Fax:817-594-5206
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX00217751223G0001X
TX277681223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice