Provider Demographics
NPI:1477601763
Name:CROUTHAMEL, DAVID W (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:CROUTHAMEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 W CHANDLER BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2508
Mailing Address - Country:US
Mailing Address - Phone:480-963-3100
Mailing Address - Fax:480-917-3023
Practice Address - Street 1:800 W CHANDLER BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2508
Practice Address - Country:US
Practice Address - Phone:480-963-3100
Practice Address - Fax:480-917-3023
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD30551223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery