Provider Demographics
NPI:1174717938
Name:CROFT, THOMAS GRIMERSON III (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GRIMERSON
Last Name:CROFT
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 HULEN ST
Mailing Address - Street 2:BLDG. C
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6863
Mailing Address - Country:US
Mailing Address - Phone:817-731-8439
Mailing Address - Fax:
Practice Address - Street 1:3600 HULEN ST
Practice Address - Street 2:BLDG. C
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6863
Practice Address - Country:US
Practice Address - Phone:817-731-8439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice