Healthcare Provider Details

I. General information

NPI: 1295739720
Provider Name (Legal Business Name): DAVID DREWRY CRICHTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 MEDICAL CENTER PT STE 260
COLORADO SPRINGS CO
80907-8721
US

IV. Provider business mailing address

1625 MEDICAL CENTER PT STE 260
COLORADO SPRINGS CO
80907-8721
US

V. Phone/Fax

Practice location:
  • Phone: 719-473-2650
  • Fax: 719-473-2508
Mailing address:
  • Phone: 719-473-2650
  • Fax: 719-473-2508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number105187
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: