Provider Demographics
NPI:1134223712
Name:CRUM, PATRICIA MARIE (DDS, MPA)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MARIE
Last Name:CRUM
Suffix:
Gender:F
Credentials:DDS, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 FULLER RD
Mailing Address - Street 2:DENTAL-160
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2335
Mailing Address - Country:US
Mailing Address - Phone:734-845-3413
Mailing Address - Fax:734-845-3200
Practice Address - Street 1:2215 FULLER RD
Practice Address - Street 2:DENTAL-160
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2335
Practice Address - Country:US
Practice Address - Phone:734-845-3413
Practice Address - Fax:734-845-3200
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010179641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice