Provider Demographics
NPI:1013992130
Name:CROUCH, ROBERT D (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:CROUCH
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:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:BESSEMER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28016-0458
Mailing Address - Country:US
Mailing Address - Phone:704-629-5761
Mailing Address - Fax:704-629-2566
Practice Address - Street 1:117 W PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BESSEMER CITY
Practice Address - State:NC
Practice Address - Zip Code:28016-2635
Practice Address - Country:US
Practice Address - Phone:704-629-5761
Practice Address - Fax:704-629-2566
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2007-08-03
Deactivation Date:2007-05-01
Deactivation Code:
Reactivation Date:2007-08-03
Provider Licenses
StateLicense IDTaxonomies
NC46261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice