MEDICARE: DR. W DALE CRUM D.D.S.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	7006	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609870070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. W DALE CRUM D.D.S.

Provider Business Mailing Address
First Line	:	2204 E 29TH AVE
Second Line	:	STE 104
City	:	SPOKANE
State	:	WA
Zip	:	99203-3961
Country	:	US
Telephone Number	:	509-928-8800
Fax Number	:	509-321-0154

Provider Business Practice Location Address
First Line	:	2204 E 29TH AVE
Second Line	:	STE 104
City	:	SPOKANE
State	:	WA
Zip	:	99203-3961
Country	:	US
Telephone Number	:	509-928-8800
Fax Number	:	509-321-0154

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	04/15/2010

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Directions to “ DR. W DALE CRUM D.D.S.” Practice Location

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