Provider Demographics
NPI:1376511642
Name:CRINZI, RICHARD A (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:CRINZI
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:15955 NE 85TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-0330
Mailing Address - Country:US
Mailing Address - Phone:425-881-3255
Mailing Address - Fax:425-885-1366
Practice Address - Street 1:15955 NE 85TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-0330
Practice Address - Country:US
Practice Address - Phone:425-881-3255
Practice Address - Fax:425-885-1366
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA41941223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
83584OtherWA LABOR & INDUSTRIES
83584OtherWA LABOR & INDUSTRIES