Provider Demographics
NPI:1386784585
Name:CRISP, ROSLYN MOORE (DDS)
Entity type:Individual
Prefix:MRS
First Name:ROSLYN
Middle Name:MOORE
Last Name:CRISP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1203 VAUGHN RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-2846
Mailing Address - Country:US
Mailing Address - Phone:336-228-8392
Mailing Address - Fax:336-227-0635
Practice Address - Street 1:1203 VAUGHN RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2846
Practice Address - Country:US
Practice Address - Phone:336-228-8392
Practice Address - Fax:336-227-0635
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC50741223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry