Healthcare Provider Details

I. General information

NPI: 1477601763
Provider Name (Legal Business Name): DAVID W CROUTHAMEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W CHANDLER BLVD SUITE 3
CHANDLER AZ
85225-2508
US

IV. Provider business mailing address

800 W CHANDLER BLVD SUITE 3
CHANDLER AZ
85225-2508
US

V. Phone/Fax

Practice location:
  • Phone: 480-963-3100
  • Fax: 480-917-3023
Mailing address:
  • Phone: 480-963-3100
  • Fax: 480-917-3023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD3055
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: