Provider Demographics
NPI:1386174589
Name:KREISHEH, GEORGE (DMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:KREISHEH
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 1:21 E PADONIA RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2306
Mailing Address - Country:US
Mailing Address - Phone:410-913-5700
Mailing Address - Fax:
Practice Address - Street 1:21 E PADONIA RD
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2306
Practice Address - Country:US
Practice Address - Phone:410-913-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN227051223G0001X
MD166861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice