Provider Demographics
NPI:1982735460
Name:CROUCH, IVUS HAROLD (DMD)
Entity Type:Individual
Prefix:DR
First Name:IVUS
Middle Name:HAROLD
Last Name:CROUCH
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:PO BOX 293
Mailing Address - Street 2:1654 US 60 WEST DR IVUS H CROUCH
Mailing Address - City:LEDBETTER
Mailing Address - State:KY
Mailing Address - Zip Code:42058
Mailing Address - Country:US
Mailing Address - Phone:270-898-2527
Mailing Address - Fax:270-898-7811
Practice Address - Street 1:1654 US 60 W
Practice Address - Street 2:
Practice Address - City:LEDBETTER
Practice Address - State:KY
Practice Address - Zip Code:42058
Practice Address - Country:US
Practice Address - Phone:270-898-2527
Practice Address - Fax:270-898-7811
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY55781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice