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General NPI Number Information
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NPI Number | 1477601763
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Entity Type | Individual
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Provider Name | DAVID W CROUTHAMEL DDS
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Gender | Male
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 800 W CHANDLER BLVD SUITE 3
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City | CHANDLER
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State | AZ
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Zip | 85225-2508
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Country | US
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Telephone | 480-963-3100
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Fax | 480-917-3023
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Provider Business Mailing Address
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Address Line | 800 W CHANDLER BLVD SUITE 3
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City | CHANDLER
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State | AZ
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Zip | 85225-2508
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Country | US
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Telephone | 480-963-3100
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Fax | 480-917-3023
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D3055
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License Number State | AZ
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