Provider Demographics
NPI:1093128159
Name:CRUMBAUGH, JENNIFER FALK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:FALK
Last Name:CRUMBAUGH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LYNNE
Other - Last Name:FALK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5680 NW PLANTATION LN
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1685
Mailing Address - Country:US
Mailing Address - Phone:785-554-2528
Mailing Address - Fax:
Practice Address - Street 1:3151 S. M-291 HIGHWAY
Practice Address - Street 2:SUITE A
Practice Address - City:INDEPENDENCE MO
Practice Address - State:MO
Practice Address - Zip Code:64057
Practice Address - Country:US
Practice Address - Phone:816-373-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014016638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist