Provider Demographics
NPI:1417920059
Name:CRIM, GARY A (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:CRIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 S PRESTON ST
Mailing Address - Street 2:UNIV. OF LOUISVILLE SCHOOL OF DENTISTRY
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1701
Mailing Address - Country:US
Mailing Address - Phone:502-852-1303
Mailing Address - Fax:502-852-3364
Practice Address - Street 1:501 S PRESTON ST
Practice Address - Street 2:UNIV. OF LOUISVILLE SCHOOL OF DENTISTRY
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1701
Practice Address - Country:US
Practice Address - Phone:502-852-1303
Practice Address - Fax:502-852-3364
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY43221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice