Provider Demographics
NPI:1740470533
Name:CROFT, DANNY R (LD)
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:R
Last Name:CROFT
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1298 SE 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324
Mailing Address - Country:US
Mailing Address - Phone:509-529-1469
Mailing Address - Fax:509-525-0387
Practice Address - Street 1:1298 SE 12TH STREET
Practice Address - Street 2:
Practice Address - City:COLLEGE PLACE
Practice Address - State:WA
Practice Address - Zip Code:99324
Practice Address - Country:US
Practice Address - Phone:509-529-1469
Practice Address - Fax:509-525-0387
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000447122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist