Provider Demographics
NPI:1548369127
Name:CRANCH, DOUGLAS AUBREY (DMD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:AUBREY
Last Name:CRANCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-3512
Mailing Address - Country:US
Mailing Address - Phone:215-924-2436
Mailing Address - Fax:
Practice Address - Street 1:2630 W CHELTENHAM AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19150-1311
Practice Address - Country:US
Practice Address - Phone:215-924-2436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS21390L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice