Provider Demographics
NPI:1609870070
Name:CRUM, W DALE (DDS)
Entity type:Individual
Prefix:DR
First Name:W DALE
Middle Name:
Last Name:CRUM
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 1:2204 E 29TH AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-3961
Mailing Address - Country:US
Mailing Address - Phone:509-928-8800
Mailing Address - Fax:509-321-0154
Practice Address - Street 1:2204 E 29TH AVE
Practice Address - Street 2:STE 104
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-3961
Practice Address - Country:US
Practice Address - Phone:509-928-8800
Practice Address - Fax:509-321-0154
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA70061223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5026117Medicaid
WAU80693Medicare UPIN
WAAB15968Medicare ID - Type Unspecified