Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 7967 | NC |
N | 122300000X | Dentist | 9277 | KY |
N | 1223D0001X | Dental Public Health | 7967 | NC |
NPI | 1669569174 |
---|---|
Provider Name | Dr. Venesa Marie Crumpley |
First Address | Charlotte, NC 28277-4520 |
Second Address | Charlotte, NC 28273-6263 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 10/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7967 | NC DENTAL LICENSE (01) | NC |
8475 | STATE DENTAL LICENSE (01) | SC |
9277 | KENTUCKY STATE DENTAL LICENSE (01) | KY |