Organization
CROUT & O'DELL ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD MORROW CROUT DDS, MS (OWNER)
(304) 562-1000
Entity
Organization
Contact information
Practice address
3518 TEAYS VALLEY RD, HURRICANE, WV 25526-9235
(304) 562-1000
(304) 562-0777
Mailing address
3518 TEAYS VALLEY RD, HURRICANE, WV 25526-9235
(304) 562-1000
(304) 562-0777
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
3374
WV
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
3824
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7900009000
—
WV
Enumeration date
09/22/2014
Last updated
09/22/2014
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