Provider Demographics
NPI:1255536603
Name:CRUNK, STANLEY R (DDS)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:R
Last Name:CRUNK
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 1:3051 KIRBY WHITTEN RD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2811
Mailing Address - Country:US
Mailing Address - Phone:901-377-3025
Mailing Address - Fax:901-377-3658
Practice Address - Street 1:3051 KIRBY WHITTEN RD
Practice Address - Street 2:SUITE #4
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2811
Practice Address - Country:US
Practice Address - Phone:901-377-3025
Practice Address - Fax:901-377-3658
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0024071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice