=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639856800
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH KATHRYN CRUMP DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2023
-----------------------------------------------------
Last Update Date | 02/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1108 PARKWAY DR STE A
-----------------------------------------------------
City | GOLDSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27534-9429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-230-0305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 107 E STARGRASS CIR
-----------------------------------------------------
City | GOLDSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27534-6394
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-357-3852
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 13690
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------