Active NPI
Samuel Dalton Crocco, DMD
- Dentist
- Port Angeles, WA
National Provider Identifier
1881256931
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 60968401
- Practice address
- 620 E 8TH St
Port Angeles, WA 98362-6224 - Phone
- (360) 457-0489
- Fax
- (360) 452-3288
- NPI assigned
- Jun 28, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 60968401 | WA | |
| Dentist | 122300000X | 60968401 | WA | Primary |
Addresses
Primary practice location
620 E 8TH St
Port Angeles, WA 98362-6224
Mailing address
620 E 8TH St
Port Angeles, WA 98362-6224
Phone (360) 457-0489
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60968401 | Other | WA | WASHINGTON STATE DEPARTMENT OF HEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60968401 | WA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Todd R Irwin DMD PLLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1561680000000",
"number": "1881256931",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "620 E 8TH ST",
"city": "PORT ANGELES",
"state": "WA",
"postal_code": "983626224",
"telephone_number": "360-457-0489",
"fax_number": "360-452-3288"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 E 8TH ST",
"city": "PORT ANGELES",
"state": "WA",
"postal_code": "983626224",
"telephone_number": "360-457-0489",
"fax_number": "360-452-3288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROCCO",
"first_name": "SAMUEL",
"middle_name": "DALTON",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-06-28",
"last_updated": "2019-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "60968401",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "60968401",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WASHINGTON STATE DEPARTMENT OF HEALTH",
"identifier": "60968401",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Angeles, WA
- Alan Crawford, RN
- Robin Lynn Crenshaw
- Crestwood Convalescent - Port Angeles LLC (Crestwood Health & Rehabilitation Center)
- Crestwood Convalescent - Port Angeles LLC (Olympic View Care)
- Carla Cribb, RN
- Dena Crosby, LPC, LMHP
- Timothy Crowley, RPH
- Pamela Cunningham
- Benjamin Robert Curran, MD
- Jeanette Lee Curry
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.