MEDICARE: DR. CRAIG OTTO PREIS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS021812L	PA

General Provider Information

NPI Number	:	1477612489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG OTTO PREIS DDS

Provider Business Mailing Address
First Line	:	3081 GREEN VALLEY RD
Second Line	:
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-4312
Country	:	US
Telephone Number	:	610-353-3379
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 KEDRON AVE
Second Line	:
City	:	FOLSOM
State	:	PA
Zip	:	19033-1310
Country	:	US
Telephone Number	:	610-532-0984
Fax Number	:	610-532-0869

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/08/2007

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