Provider Demographics
NPI:1649350125
Name:CRUPI, BRIAN V (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:V
Last Name:CRUPI
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 1:5241 MAHOGANY RUN AVE
Mailing Address - Street 2:APT 413
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34241-9188
Mailing Address - Country:US
Mailing Address - Phone:941-927-8330
Mailing Address - Fax:
Practice Address - Street 1:5561 BROADCAST CT
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-8472
Practice Address - Country:US
Practice Address - Phone:941-373-3904
Practice Address - Fax:941-907-0565
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN166921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice