=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932329182
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN A CRUMPTON DMD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2007
-----------------------------------------------------
Last Update Date | 10/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36 ROPER CORNERS CIRCLE
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-297-8418
-----------------------------------------------------
Fax | 864-297-8073
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36 ROPER CORNERS CIRCLE
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-297-8418
-----------------------------------------------------
Fax | 864-297-8073
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN A CRUMPTON SR.
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 864-297-8418
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number | 514
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------