Provider Demographics
NPI:1346439080
Name:ROBERT L. CRITCHFIELD DDS PC
Entity Type:Organization
Organization Name:ROBERT L. CRITCHFIELD DDS PC
Other - Org Name:CRITCHFIELD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRITCHFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-943-7204
Mailing Address - Street 1:18275 N 59TH AVE STE D120
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1266
Mailing Address - Country:US
Mailing Address - Phone:602-943-7204
Mailing Address - Fax:602-943-1534
Practice Address - Street 1:18275 N 59TH AVE STE D120
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1266
Practice Address - Country:US
Practice Address - Phone:602-943-7204
Practice Address - Fax:602-943-1534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty