Healthcare Provider Details

I. General information

NPI: 1104925593
Provider Name (Legal Business Name): CINDY LEE CROY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W AIRPORT RD
PAYSON AZ
85541-3607
US

IV. Provider business mailing address

1040 W BRIDLE PATH LN
PAYSON AZ
85541-3016
US

V. Phone/Fax

Practice location:
  • Phone: 928-474-3016
  • Fax:
Mailing address:
  • Phone: 928-474-0136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number1444
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: