Provider Demographics
NPI:1275503740
Name:CROOKS, ROBERT MOORE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MOORE
Last Name:CROOKS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 BLANDING ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3519
Mailing Address - Country:US
Mailing Address - Phone:803-779-8303
Mailing Address - Fax:803-779-2198
Practice Address - Street 1:1901 BLANDING ST
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3519
Practice Address - Country:US
Practice Address - Phone:803-779-8303
Practice Address - Fax:803-779-2198
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1922-2361223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9885Medicaid