Healthcare Provider Details

I. General information

NPI: 1285717579
Provider Name (Legal Business Name): DARCY CATHERINE CRUIKSHANK DMD MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 MOUNTAIN VIEW LANE #100
FOREST GROVE OR
97116-2382
US

IV. Provider business mailing address

4475 NW NESKOWIN AVE
PORTLAND OR
97229-2803
US

V. Phone/Fax

Practice location:
  • Phone: 503-359-5408
  • Fax: 503-359-0584
Mailing address:
  • Phone: 503-705-7161
  • Fax: 503-359-0584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD8508
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: