Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 3479 | SC |
NPI | 1215180716 |
---|---|
Provider Name | Dr. John Anthony Crumpton SR. |
First Address | Greenville, SC 29615 |
Second Address | Greenville, SC 29615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2008 |
Last Update Date | 06/10/2020 |