Individual
DR. SAMUEL DALTON CROCCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
620 E 8TH ST, PORT ANGELES, WA 98362-6224
(360) 457-0489
(360) 452-3288
Mailing address
620 E 8TH ST, PORT ANGELES, WA 98362-6224
(360) 457-0489
(360) 452-3288
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
60968401
WA
1223G0001X
General Practice Dentistry
60968401
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60968401
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
Enumeration date
06/28/2019
Last updated
06/28/2019
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