Provider Demographics
NPI:1992779730
Name:CRAPANZANO, LEROY S JR (DDS)
Entity type:Individual
Prefix:DR
First Name:LEROY
Middle Name:S
Last Name:CRAPANZANO
Suffix:JR
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 1:157 PARAGON PARKWAY SUITE 800
Mailing Address - Street 2:HAYWOOD COUNTY HEALTH DEPARTMENT
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721
Mailing Address - Country:US
Mailing Address - Phone:828-452-6701
Mailing Address - Fax:
Practice Address - Street 1:157 PARAGON PARKWAY
Practice Address - Street 2:HAYWOOD COUNTY HEALTH DEPARTMENT
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721
Practice Address - Country:US
Practice Address - Phone:828-452-6701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900093Medicaid