Provider Demographics
NPI:1396889440
Name:CRUSON, JAMES WILLIAM (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIAM
Last Name:CRUSON
Suffix:
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 1:1389 LAMOILLE HWY
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-4317
Mailing Address - Country:US
Mailing Address - Phone:775-753-8670
Mailing Address - Fax:775-753-2460
Practice Address - Street 1:1389 LAMOILLE HWY
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-4317
Practice Address - Country:US
Practice Address - Phone:775-753-8670
Practice Address - Fax:775-753-2460
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV022171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice