Provider Demographics
NPI:1962538256
Name:CREESE, RICHARD D (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:CREESE
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 1:450 SUTTER ST RM 2031
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4109
Mailing Address - Country:US
Mailing Address - Phone:415-986-5886
Mailing Address - Fax:415-986-5250
Practice Address - Street 1:450 SUTTER ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4206
Practice Address - Country:US
Practice Address - Phone:415-986-5886
Practice Address - Fax:415-986-5250
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA239981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA23998OtherDENTIST