Provider Demographics
NPI:1528294238
Name:CROUCH, RODDIE (DDS)
Entity type:Individual
Prefix:
First Name:RODDIE
Middle Name:
Last Name:CROUCH
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 1:2125 POST OAK TRITT RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-1609
Mailing Address - Country:US
Mailing Address - Phone:770-977-9090
Mailing Address - Fax:770-578-8289
Practice Address - Street 1:2125 POST OAK TRITT RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-1609
Practice Address - Country:US
Practice Address - Phone:770-977-9090
Practice Address - Fax:770-578-8289
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN084841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice