Provider Demographics
NPI:1265654032
Name:CRUTCHER, WAYNE (DDS)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:CRUTCHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 ALTOS OAKS DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5493
Mailing Address - Country:US
Mailing Address - Phone:650-941-4411
Mailing Address - Fax:650-941-4477
Practice Address - Street 1:843 ALTOS OAKS DR
Practice Address - Street 2:SUITE 2
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5493
Practice Address - Country:US
Practice Address - Phone:650-941-4411
Practice Address - Fax:650-941-4477
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA350921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice