MEDICARE: DR. PETER MCKNIGHT CRUMP DDS,MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	12164	MO

General Provider Information

NPI Number	:	1164431045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER MCKNIGHT CRUMP DDS,MS

Provider Business Mailing Address
First Line	:	24 S GORE AVE
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-2910
Country	:	US
Telephone Number	:	131-496-2624
Fax Number	:	131-496-2303

Provider Business Practice Location Address
First Line	:	24 S GORE AVE
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-2910
Country	:	US
Telephone Number	:	314-962-6242
Fax Number	:	314-962-3030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	07/08/2007

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