Provider Demographics
NPI:1174085971
Name:EXPLORER PEDIATRIC DENTISTRY, LLC- JULIE RUDGERS CROFT, DDS
Entity type:Organization
Organization Name:EXPLORER PEDIATRIC DENTISTRY, LLC- JULIE RUDGERS CROFT, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUDGERS CROFT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:234-602-2555
Mailing Address - Street 1:2881 HASTINGS RD
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44224-3755
Mailing Address - Country:US
Mailing Address - Phone:330-861-9192
Mailing Address - Fax:
Practice Address - Street 1:725 W STREETSBORO ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-2056
Practice Address - Country:US
Practice Address - Phone:234-602-2555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental