Individual
MR. DEXTER CROUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
14872 BELLAMY CT, FISHERS, IN 46037-5545
(317) 954-8417
Mailing address
14872 BELLAMY CT, FISHERS, IN 46037-5545
(317) 954-8417
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
22-015538-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22-015538-1
PERSONAL SERVICE AGENCY LICENSE
IN
Enumeration date
05/19/2022
Last updated
05/19/2022
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