Healthcare Provider Details

I. General information

NPI: 1285825307
Provider Name (Legal Business Name): ERIC R CRUM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 11/21/2022
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

1000 W CARSON ST # 25
TORRANCE CA
90502-2004
US

V. Phone/Fax

Practice location:
  • Phone: 424-306-4263
  • Fax: 310-533-2210
Mailing address:
  • Phone: 424-306-4263
  • Fax: 310-533-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD 8462
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number59969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: