Healthcare Provider Details

I. General information

NPI: 1184886657
Provider Name (Legal Business Name): JUDE CRUTCHFIELD D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5420 PARK DR
ROCKLIN CA
95765-5562
US

IV. Provider business mailing address

3870 IRON WHEEL CT
ROCKLIN CA
95765-4655
US

V. Phone/Fax

Practice location:
  • Phone: 916-660-2904
  • Fax:
Mailing address:
  • Phone: 916-660-2904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number58211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: