MEDICARE: DR. ROLF O CRICHTON DDS

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	1223G0001X	General Practice Dentistry	D3879	ID

General Provider Information

NPI Number	:	1821158080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROLF O CRICHTON DDS

Provider Business Mailing Address
First Line	:	10233 W OVERLAND RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-1430
Country	:	US
Telephone Number	:	208-323-4700
Fax Number	:	208-323-9409

Provider Business Practice Location Address
First Line	:	10233 W OVERLAND RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-1430
Country	:	US
Telephone Number	:	208-323-4700
Fax Number	:	208-323-9409

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	12/03/2007

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