Provider Demographics
NPI:1720250871
Name:CRESS, JUSTIN C (DDS)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:C
Last Name:CRESS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 GREEN ACRES DR STE 1
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3353
Mailing Address - Country:US
Mailing Address - Phone:208-733-3345
Mailing Address - Fax:208-735-5211
Practice Address - Street 1:871 GREEN ACRES DR STE 1
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3353
Practice Address - Country:US
Practice Address - Phone:208-544-4848
Practice Address - Fax:208-735-5211
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3391122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807712200Medicaid