Provider Demographics
NPI:1902814965
Name:CRUMP, GARY WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:WILLIAM
Last Name:CRUMP
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 1:2013 CANTON RD NW
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615-9753
Mailing Address - Country:US
Mailing Address - Phone:330-627-2375
Mailing Address - Fax:330-627-2375
Practice Address - Street 1:2013 CANTON RD NW
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-9753
Practice Address - Country:US
Practice Address - Phone:330-627-2375
Practice Address - Fax:330-627-2375
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0208680Medicaid