Provider Demographics
NPI:1689678252
Name:CRUMP, THOMAS BRADLEY (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BRADLEY
Last Name:CRUMP
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 1:3100 MONTICELLO AVE
Mailing Address - Street 2:STE 825
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-3437
Mailing Address - Country:US
Mailing Address - Phone:214-443-0876
Mailing Address - Fax:214-443-0877
Practice Address - Street 1:3100 MONTICELLO AVE
Practice Address - Street 2:STE 825
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3437
Practice Address - Country:US
Practice Address - Phone:214-443-0876
Practice Address - Fax:214-443-0877
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2017-03-06
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
TX189971223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics