Organization
DR. KEITH A. CROUCH DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH A. CROUCH DDS PA (PRESIDENT)
(704) 873-9641
Entity
Organization
Contact information
Practice address
511 BROOKDALE DR, STATESVILLE, NC 28677-4107
(704) 873-9641
(704) 873-1544
Mailing address
511 BROOKDALE DR, 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
09/13/2012
Last updated
09/13/2012
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