Provider Demographics
NPI:1538242631
Name:CRUME, RONALD G JR (DMD MS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:G
Last Name:CRUME
Suffix:JR
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 MALL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1496
Mailing Address - Country:US
Mailing Address - Phone:859-647-7600
Mailing Address - Fax:859-647-0213
Practice Address - Street 1:7901 MALL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1496
Practice Address - Country:US
Practice Address - Phone:859-647-7600
Practice Address - Fax:859-647-0213
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6300122300000X
OH20503122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1637201Medicare ID - Type Unspecified
U59437Medicare UPIN