Provider Demographics
NPI:1669569174
Name:CRUMPLEY, VENESA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:VENESA
Middle Name:MARIE
Last Name:CRUMPLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6618 SETON HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4520
Mailing Address - Country:US
Mailing Address - Phone:910-691-8984
Mailing Address - Fax:
Practice Address - Street 1:2630 W ARROWOOD RD STE C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6263
Practice Address - Country:US
Practice Address - Phone:980-263-2330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7967122300000X, 1223D0001X
KY9277122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8475OtherSTATE DENTAL LICENSE
KY9277OtherKENTUCKY STATE DENTAL LICENSE
NC7967OtherNC DENTAL LICENSE