Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 1792 | SC |
NPI | 1659389567 |
---|---|
Provider Name | Dr. Danny Keith Crout |
First Address | Spartanburg, SC 29301-2652 |
Second Address | Spartanburg, SC 29301-2652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U74327 | (02) |