Provider Demographics
NPI:1447323209
Name:CRUEY, STEPHEN DALE (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DALE
Last Name:CRUEY
Suffix:
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 1:3622 E MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-1274
Mailing Address - Country:US
Mailing Address - Phone:423-587-0993
Mailing Address - Fax:
Practice Address - Street 1:3622 E MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-1274
Practice Address - Country:US
Practice Address - Phone:423-587-0993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN. D.S.40101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice