Healthcare Provider Details

I. General information

NPI: 1831391499
Provider Name (Legal Business Name): THANE EVANS CRUMP DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
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: 605-753-6824
  • Fax:
Mailing address:
  • Phone: 605-753-6824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. THANE CRUMP
Title or Position: DENTIST, OWNER
Credential: DDS
Phone: 605-753-6824