Provider Demographics
NPI:1891841102
Name:CRABTREE, MARK ANDERSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDERSON
Last Name:CRABTREE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 STARLING AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-3731
Mailing Address - Country:US
Mailing Address - Phone:276-632-9266
Mailing Address - Fax:
Practice Address - Street 1:407 STARLING AVE
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3731
Practice Address - Country:US
Practice Address - Phone:276-632-9266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010065351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice