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NPI Code Detail

MEDICARE: CRUTCHFIELD PEDIATRIC DENTAL GROUP

MEDICARE: CRUTCHFIELD PEDIATRIC DENTAL GROUP
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
11223P0221XPediatric Dentistry58211CA

General Provider Information

NPI Number : 1033639463
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRUTCHFIELD PEDIATRIC DENTAL GROUP
Provider Business Mailing Address
First Line : 5420 PARK DR
Second Line :
City : ROCKLIN
State : CA
Zip : 95765-5562
Country : US
Telephone Number : 916-435-5230
Fax Number :
Provider Business Practice Location Address
First Line : 6560 LONETREE BLVD STE 102
Second Line :
City : ROCKLIN
State : CA
Zip : 95765-5891
Country : US
Telephone Number : 916-773-5230
Fax Number : 916-474-5249
Authorized Official
Title or Position : OWNER
Name : DR. JUDE CRUTCHFIELD
Credential : DMD
Telephone Number : 916-773-5230
Provider Enumeration Date : 06/27/2017
Last Update Date : 10/24/2024

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Directions to “CRUTCHFIELD PEDIATRIC DENTAL GROUP ” Practice Location

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