Provider Demographics
NPI:1912900986
Name:CROGHAN, THOMAS JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:CROGHAN
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 1:44250 E 168TH AVE
Mailing Address - Street 2:
Mailing Address - City:KEENESBURG
Mailing Address - State:CO
Mailing Address - Zip Code:80643-9711
Mailing Address - Country:US
Mailing Address - Phone:720-735-9121
Mailing Address - Fax:720-735-9121
Practice Address - Street 1:100 S. MAIN ST
Practice Address - Street 2:
Practice Address - City:KEENESBURG
Practice Address - State:CO
Practice Address - Zip Code:80643
Practice Address - Country:US
Practice Address - Phone:303-377-8662
Practice Address - Fax:303-377-4785
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO74621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice