Provider Demographics
NPI:1285717579
Name:CRUIKSHANK, DARCY CATHERINE (DMD MSD)
Entity type:Individual
Prefix:MRS
First Name:DARCY
Middle Name:CATHERINE
Last Name:CRUIKSHANK
Suffix:
Gender:F
Credentials:DMD MSD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4475 NW NESKOWIN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-2803
Mailing Address - Country:US
Mailing Address - Phone:503-705-7161
Mailing Address - Fax:503-359-0584
Practice Address - Street 1:1911 MOUNTAIN VIEW LANE
Practice Address - Street 2:#100
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2382
Practice Address - Country:US
Practice Address - Phone:503-359-5408
Practice Address - Fax:503-359-0584
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD85081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics