MEDICARE: DR. DOUGLAS AUBREY CRANCH DMD

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	DS21390L	PA

General Provider Information

NPI Number	:	1548369127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS AUBREY CRANCH DMD

Provider Business Mailing Address
First Line	:	304 ROBERTS AVE
Second Line	:
City	:	GLENSIDE
State	:	PA
Zip	:	19038-3512
Country	:	US
Telephone Number	:	215-924-2436
Fax Number	:

Provider Business Practice Location Address
First Line	:	2630 W CHELTENHAM AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19150-1311
Country	:	US
Telephone Number	:	215-924-2436
Fax Number	:

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/08/2007

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