Provider Demographics
NPI:1265421358
Name:CROPP, GREGORY MICHAEL I (DMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MICHAEL
Last Name:CROPP
Suffix:I
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5690 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-3565
Mailing Address - Country:US
Mailing Address - Phone:814-836-0667
Mailing Address - Fax:814-836-9746
Practice Address - Street 1:5690 PERRY HWY
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-3565
Practice Address - Country:US
Practice Address - Phone:814-836-0667
Practice Address - Fax:814-836-9746
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-029664-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01800760Medicaid