Provider Demographics
NPI:1144421900
Name:JAMES J. CRUMBAKER, DDS PC
Entity Type:Organization
Organization Name:JAMES J. CRUMBAKER, DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRUMBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-476-7162
Mailing Address - Street 1:85 WASHINGTON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-4297
Mailing Address - Country:US
Mailing Address - Phone:802-476-7162
Mailing Address - Fax:802-476-7120
Practice Address - Street 1:85 WASHINGTON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-4297
Practice Address - Country:US
Practice Address - Phone:802-476-7162
Practice Address - Fax:802-476-7120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00020291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006389Medicaid