Healthcare Provider Details

I. General information

NPI: 1932943800
Provider Name (Legal Business Name): EMILY ELIZABETH CRUSINBERRY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12123 LITTLE RD
HUDSON FL
34667-2924
US

IV. Provider business mailing address

10131 CHERRY CREEK LN
PORT RICHEY FL
34668-3709
US

V. Phone/Fax

Practice location:
  • Phone: 727-379-9250
  • Fax:
Mailing address:
  • Phone: 316-644-2831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN29134
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: