Crouch, Keith Allen
Crouch, Keith Allen is an sole proprietor health care provider with primary practice located at 511 Brookdale Drive , Statesville NC 28677-4107. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Crouch, Keith Allen can be contacted via phone (704) 873-9641.Contact Information
Primary practice address
511 Brookdale Drive
Statesville NC 28677-4107
Phone: (704) 873-9641
Fax: (704) 873-1544
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 5075 | North Carolina |
Profile Details
| NPI number | 1164508743 |
|---|---|
| LBN Legal business name | Crouch, Keith Allen |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 27th, 2006 |
| Last updated | Feb 14th, 2011 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1164508743 | NPPES |
| North Carolina | MEDICAID | 8991922 |
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