Provider Demographics
NPI:1679692164
Name:TODD, ROBERT CROCKETT III (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CROCKETT
Last Name:TODD
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 EVANS CITY RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-2754
Mailing Address - Country:US
Mailing Address - Phone:724-282-7774
Mailing Address - Fax:724-282-7748
Practice Address - Street 1:291 EVANS CITY RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2754
Practice Address - Country:US
Practice Address - Phone:724-282-7774
Practice Address - Fax:724-282-7748
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-021692-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist