Provider Demographics
NPI:1376673855
Name:BRIAN CRUPI, D.D.S., PA
Entity Type:Organization
Organization Name:BRIAN CRUPI, D.D.S., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:V
Authorized Official - Last Name:CRUPI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:941-993-4699
Mailing Address - Street 1:2828 S MCCALL RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224-7791
Mailing Address - Country:US
Mailing Address - Phone:941-475-9915
Mailing Address - Fax:
Practice Address - Street 1:2828 S MCCALL RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224-7791
Practice Address - Country:US
Practice Address - Phone:941-475-9915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16692122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty