Healthcare Provider Details

I. General information

NPI: 1013992130
Provider Name (Legal Business Name): ROBERT D CROUCH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 08/03/2007
Certification Date:
Deactivation Date: 05/01/2007
Reactivation Date: 08/03/2007

III. Provider practice location address

117 W PENNSYLVANIA AVE
BESSEMER CITY NC
28016-2635
US

IV. Provider business mailing address

PO BOX 458
BESSEMER CITY NC
28016-0458
US

V. Phone/Fax

Practice location:
  • Phone: 704-629-5761
  • Fax: 704-629-2566
Mailing address:
  • Phone: 704-629-5761
  • Fax: 704-629-2566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4626
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: