Provider Demographics
NPI:1982006938
Name:CROUT & O'DELL ORTHODONTICS
Entity Type:Organization
Organization Name:CROUT & O'DELL ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MORROW
Authorized Official - Last Name:CROUT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:304-562-1000
Mailing Address - Street 1:3518 TEAYS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9235
Mailing Address - Country:US
Mailing Address - Phone:304-562-1000
Mailing Address - Fax:304-562-0777
Practice Address - Street 1:3518 TEAYS VALLEY RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9235
Practice Address - Country:US
Practice Address - Phone:304-562-1000
Practice Address - Fax:304-562-0777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV33741223X0400X
WV38241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7900009000Medicaid