Provider Demographics
NPI:1629141650
Name:BOB CRUM ORTHODONTICS, PC
Entity Type:Organization
Organization Name:BOB CRUM ORTHODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:CRUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-745-5051
Mailing Address - Street 1:801 N WILMOT RD
Mailing Address - Street 2:#F-2
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1711
Mailing Address - Country:US
Mailing Address - Phone:520-745-5051
Mailing Address - Fax:520-745-1121
Practice Address - Street 1:801 N WILMOT RD
Practice Address - Street 2:#F-2
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1711
Practice Address - Country:US
Practice Address - Phone:520-745-5051
Practice Address - Fax:520-745-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14581223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty