Healthcare Provider Details

I. General information

NPI: 1710195896
Provider Name (Legal Business Name): THANE CRUMP DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 4TH ST NE SUITE 208
WATERTOWN SD
57201-1898
US

IV. Provider business mailing address

600 4TH ST NE SUITE 208
WATERTOWN SD
57201-1898
US

V. Phone/Fax

Practice location:
  • Phone: 605-753-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberM 750
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberM 750
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: