Provider Demographics
NPI:1861796336
Name:ROBERT M. CROOKS, JR., D.M.D.
Entity type:Organization
Organization Name:ROBERT M. CROOKS, JR., D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:CROOKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-779-8303
Mailing Address - Street 1:1901 BLANDING ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3581
Mailing Address - Country:US
Mailing Address - Phone:803-779-8303
Mailing Address - Fax:803-779-2198
Practice Address - Street 1:1901 BLANDING ST
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3581
Practice Address - Country:US
Practice Address - Phone:803-779-8303
Practice Address - Fax:803-779-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19221223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty