Provider Demographics
NPI:1346209194
Name:CRUMPTON, BRENT JOHNSON (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:JOHNSON
Last Name:CRUMPTON
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 E MAIN ST
Mailing Address - Street 2:STE 2E
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-4031
Mailing Address - Country:US
Mailing Address - Phone:662-823-3636
Mailing Address - Fax:662-823-3660
Practice Address - Street 1:210 E MAIN ST
Practice Address - Street 2:STE 2E
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-4031
Practice Address - Country:US
Practice Address - Phone:662-823-3636
Practice Address - Fax:662-823-3660
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSENDO-381-041223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics