Provider Demographics
NPI:1033264775
Name:CRUSE, HAROLD M (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:M
Last Name:CRUSE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13841 HULL STREET RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2056
Mailing Address - Country:US
Mailing Address - Phone:804-744-1280
Mailing Address - Fax:804-744-2564
Practice Address - Street 1:13841 HULL STREET RD
Practice Address - Street 2:SUITE 5
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2056
Practice Address - Country:US
Practice Address - Phone:804-744-1280
Practice Address - Fax:804-744-2564
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04969122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA04969OtherVA STATE LICENSE NUMBER