Provider Demographics
NPI:1568640464
Name:CRUMP, MISTY MCCURRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MISTY
Middle Name:MCCURRY
Last Name:CRUMP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8938 KINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2730
Mailing Address - Country:US
Mailing Address - Phone:318-686-3899
Mailing Address - Fax:318-686-3997
Practice Address - Street 1:8938 KINGSTON RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2730
Practice Address - Country:US
Practice Address - Phone:318-686-3899
Practice Address - Fax:318-686-3997
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist