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General NPI Number Information
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NPI Number | 1144898529
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Entity Type | Individual
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Provider Name | JARED CRUTCHER DMD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 3740 E LAKE CTR
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City | QUINCY
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State | IL
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Zip | 62305-5805
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Country | US
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Telephone | 217-214-4545
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Fax |
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Provider Business Mailing Address
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Address Line | 1031 KENTUCKY ST
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City | QUINCY
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State | IL
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Zip | 62301-4211
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Country | US
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Telephone | 618-402-8890
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.033129
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License Number State | IL
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