Provider Demographics
NPI:1427137579
Name:CRUM, RICHARD L (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:CRUM
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 1:12605 RANCHERIA DR
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-9498
Mailing Address - Country:US
Mailing Address - Phone:209-847-9947
Mailing Address - Fax:
Practice Address - Street 1:200 VERA AVE
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:CA
Practice Address - Zip Code:95366-2345
Practice Address - Country:US
Practice Address - Phone:209-599-4239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice