Individual
MR. KEITH ALLEN CROUCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
511 BROOKDALE DRIVE, STATESVILLE, NC 28677-4107
(704) 873-9641
(704) 873-1544
Mailing address
511 BROOKDALE DRIVE, STATESVILLE, NC 28677-4107
(704) 873-9641
(704) 873-1544
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5075
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8991922
—
NC
Enumeration date
10/27/2006
Last updated
02/14/2011
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