Healthcare Provider Details

I. General information

NPI: 1043338031
Provider Name (Legal Business Name): JAMES R CRYDER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11329 SPRINGFIELD PIKE
CINCINNATI OH
45246-4201
US

IV. Provider business mailing address

11329 SPRINGFIELD PIKE
CINCINNATI OH
45246-4201
US

V. Phone/Fax

Practice location:
  • Phone: 513-772-1671
  • Fax: 513-771-1155
Mailing address:
  • Phone: 513-772-1671
  • Fax: 513-771-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30-017448
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: