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General NPI Number Information
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NPI Number | 1497090864
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Entity Type | Organization
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Legal Business Name | MELVIN E. CRUSER III, DDS
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Dates
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Enumeration Date | 12/11/2012
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Last Update Date | 12/11/2012
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Provider Practice Location Address
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Address Line | 1209 INDEPENDENCE BLVD SUITE 110
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-5568
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Country | US
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Telephone | 757-490-3111
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Fax | 757-499-8768
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Provider Business Mailing Address
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Address Line | 1209 INDEPENDENCE BLVD SUITE 110
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-5568
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Country | US
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Telephone | 757-490-3111
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Fax | 757-499-8768
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SARA S CRUSER
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Credential |
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Telephone | 757-490-3111
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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 | 0401005830
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License Number State | VA
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