Provider Demographics
NPI:1497376362
Name:CRUCIAN, CARRIE (RDH)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:CRUCIAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:BOBROWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:1364 SW LESCHI DR
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-5838
Mailing Address - Country:US
Mailing Address - Phone:252-571-8557
Mailing Address - Fax:
Practice Address - Street 1:3475 N SARATOGA ST
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98278-4927
Practice Address - Country:US
Practice Address - Phone:360-257-2302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-02
Last Update Date:2020-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11671124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist