Provider Demographics
NPI:1881926921
Name:CRUTCHFIELD, ALLISON TAR (DMD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:TAR
Last Name:CRUTCHFIELD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 E CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-5575
Mailing Address - Country:US
Mailing Address - Phone:269-327-3005
Mailing Address - Fax:
Practice Address - Street 1:1112 E CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-5575
Practice Address - Country:US
Practice Address - Phone:269-327-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-30
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020145122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist