Provider Demographics
NPI:1720101140
Name:CREECH, JOHN LEWIS III (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEWIS
Last Name:CREECH
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7980 NEW LAGRANGE RD
Mailing Address - Street 2:UNIT #2
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4767
Mailing Address - Country:US
Mailing Address - Phone:502-412-3636
Mailing Address - Fax:
Practice Address - Street 1:7980 NEW LAGRANGE RD
Practice Address - Street 2:UNIT #2
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4767
Practice Address - Country:US
Practice Address - Phone:502-412-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY55161223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics