# DR. GORDON G CROFT

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1417126244
- **Gender:** Man
- **Credential:** D.M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D1518 | ID | Yes |

## Other

- **Enumeration date:** 02/26/2008
- **Last updated:** 04/23/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000789200 | — | ID |
| 01 | — | 462879 | UNITED CONCORDIA | ID |
| 01 | — | 6C396 | BLUE CROSS | ID |