Provider Demographics
NPI:1659520617
Name:CROFT, DEVIN L (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:L
Last Name:CROFT
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9772 W YEARLING RD
Mailing Address - Street 2:STE A1600
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1380
Mailing Address - Country:US
Mailing Address - Phone:623-566-0800
Mailing Address - Fax:
Practice Address - Street 1:9772 W YEARLING RD
Practice Address - Street 2:STE A1600
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1380
Practice Address - Country:US
Practice Address - Phone:623-566-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD76161223S0112X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ518939Medicaid
AZ162964Medicaid