Provider Demographics
NPI:1467672311
Name:CROLL, THEODORE PHILIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:PHILIP
Last Name:CROLL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 N SHADY RETREAT RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2503
Mailing Address - Country:US
Mailing Address - Phone:215-348-3745
Mailing Address - Fax:215-345-6035
Practice Address - Street 1:708 N SHADY RETREAT RD
Practice Address - Street 2:SUITE 2
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2503
Practice Address - Country:US
Practice Address - Phone:215-348-3745
Practice Address - Fax:215-345-6035
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018004L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry