MEDICARE: DR. DAVID DREWRY CRICHTON 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	105187	CO

General Provider Information

NPI Number	:	1295739720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID DREWRY CRICHTON DDS

Provider Business Mailing Address
First Line	:	1625 MEDICAL CENTER PT
Second Line	:	STE 260
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-8721
Country	:	US
Telephone Number	:	719-473-2650
Fax Number	:	719-473-2508

Provider Business Practice Location Address
First Line	:	1625 MEDICAL CENTER PT
Second Line	:	STE 260
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-8721
Country	:	US
Telephone Number	:	719-473-2650
Fax Number	:	719-473-2508

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/08/2007

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