Provider Demographics
NPI:1528548955
Name:MICHAEL ALTON CRUMP
Entity Type:Organization
Organization Name:MICHAEL ALTON CRUMP
Other - Org Name:COOSA FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALTON
Authorized Official - Last Name:CRUMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-438-0080
Mailing Address - Street 1:104 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5235
Mailing Address - Country:US
Mailing Address - Phone:256-438-0080
Mailing Address - Fax:
Practice Address - Street 1:104 CHERRY ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5235
Practice Address - Country:US
Practice Address - Phone:256-438-0080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental