Healthcare Provider Details

I. General information

NPI: 1730220476
Provider Name (Legal Business Name): ROBERT R CROFT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 MAYFIELD DR STE D
SMYRNA TN
37167-3035
US

IV. Provider business mailing address

974 HARSH LN
CASTALIAN SPRINGS TN
37031-4545
US

V. Phone/Fax

Practice location:
  • Phone: 615-355-5822
  • Fax: 615-355-5899
Mailing address:
  • Phone: 209-404-2771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberB20093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: