Provider Demographics
NPI:1992893226
Name:CRUSER, MELVIN E III (DDS)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:E
Last Name:CRUSER
Suffix:III
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 1:1209 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5568
Mailing Address - Country:US
Mailing Address - Phone:757-490-3111
Mailing Address - Fax:757-499-8768
Practice Address - Street 1:1209 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5568
Practice Address - Country:US
Practice Address - Phone:757-490-3111
Practice Address - Fax:757-499-8768
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010058301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice