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General NPI Number Information
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NPI Number | 1255521209
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Entity Type | Organization
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Legal Business Name | ROBERT R CROFT INC
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 07/26/2007
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Provider Practice Location Address
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Address Line | 1236 FLOYD AVE SUITE C
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City | MODESTO
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State | CA
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Zip | 95350-2471
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Country | US
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Telephone | 209-524-5515
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Fax | 209-524-5386
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Provider Business Mailing Address
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Address Line | 1236 FLOYD AVE SUITE C
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City | MODESTO
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State | CA
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Zip | 95350-2471
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Country | US
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Telephone | 209-524-5515
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Fax | 209-524-5683
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT R CROFT
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Credential | DDS
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Telephone | 209-524-5515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 20093
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License Number State | CA
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