Provider Demographics
NPI:1558751321
Name:CROUCH, CHRISTINE (RDH)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:CROUCH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 STERLING DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-3039
Mailing Address - Country:US
Mailing Address - Phone:530-339-1900
Mailing Address - Fax:
Practice Address - Street 1:116 W MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:MCCLOUD
Practice Address - State:CA
Practice Address - Zip Code:96057
Practice Address - Country:US
Practice Address - Phone:530-964-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24319124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist