MEDICARE: MRS. DARCY CATHERINE CRUIKSHANK DMD MSD

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	D8508	OR

General Provider Information

NPI Number	:	1285717579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DARCY CATHERINE CRUIKSHANK DMD MSD

Provider Business Mailing Address
First Line	:	4475 NW NESKOWIN AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97229-2803
Country	:	US
Telephone Number	:	503-705-7161
Fax Number	:	503-359-0584

Provider Business Practice Location Address
First Line	:	1911 MOUNTAIN VIEW LANE
Second Line	:	#100
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2382
Country	:	US
Telephone Number	:	503-359-5408
Fax Number	:	503-359-0584

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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Directions to “ MRS. DARCY CATHERINE CRUIKSHANK DMD MSD” Practice Location

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