NPIMap

Organization Active NPI

Charles Croasdill DMD PLLC

  • Dental Clinic/Center
  • Tacoma, WA
National Provider Identifier
1104067198
Registry record updated Mar 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
5005 Issued in WA
Legal business name
CHARLES CROASDILL DMD PLLC
Practice address
2520 N Alder St
Tacoma, WA 98406-6632
Phone
(253) 759-5414
NPI assigned
Mar 20, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Charles Croasdill Watson Croasdill, DMD
Title
Owner
Phone
(253) 759-5414

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 5005 WA Primary

Addresses

Primary practice location

2520 N Alder St
Tacoma, WA 98406-6632

Mailing address

2520 N Alder St
Tacoma, WA 98406-6632
Phone (253) 759-5414

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1237507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237507200000",
    "number": "1104067198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2520 N ALDER ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984066632",
            "telephone_number": "253-759-5414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2520 N ALDER ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984066632",
            "telephone_number": "253-759-5414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES CROASDILL DMD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-20",
        "last_updated": "2009-03-20",
        "status": "A",
        "authorized_official_last_name": "CROASDILL",
        "authorized_official_first_name": "CHARLES CROASDILL",
        "authorized_official_middle_name": "WATSON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-759-5414",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WA",
            "license": "5005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.