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General NPI Number Information
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NPI Number | 1881985398
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Entity Type | Organization
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Legal Business Name | ROSLYN M. CRISP DD, MS, PA
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Dates
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Enumeration Date | 05/02/2011
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 1203 VAUGHN RD
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City | BURLINGTON
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State | NC
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Zip | 27217-2846
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Country | US
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Telephone | 336-228-8392
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Fax | 336-227-0635
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Provider Business Mailing Address
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Address Line | 1203 VAUGHN RD
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City | BURLINGTON
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State | NC
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Zip | 27217-2846
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Country | US
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Telephone | 336-228-8392
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Fax | 336-227-0635
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MR. PETE MOORE
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Credential |
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Telephone | 336-524-5439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 200001988472
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License Number State | NC
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