Provider Demographics
NPI:1043542434
Name:CRUTCHFIELD, CARLSIE LYNNETTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLSIE
Middle Name:LYNNETTE
Last Name:CRUTCHFIELD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8520 LANDEN DR
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-9565
Mailing Address - Country:US
Mailing Address - Phone:513-909-4746
Mailing Address - Fax:937-999-6500
Practice Address - Street 1:8520 LANDEN DR
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-9565
Practice Address - Country:US
Practice Address - Phone:513-909-4746
Practice Address - Fax:937-999-6500
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.023156122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist