MEDICARE: DR. KENNETH OWEN CROSBY II D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	33447	CA
2	1223P0221X	Pediatric Dentistry	33447	CA

General Provider Information

NPI Number	:	1245293869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH OWEN CROSBY II D.D.S

Provider Business Mailing Address
First Line	:	6079 N FRESNO ST
Second Line	:	STE 105
City	:	FRESNO
State	:	CA
Zip	:	93710-5276
Country	:	US
Telephone Number	:	559-222-7001
Fax Number	:	559-222-7087

Provider Business Practice Location Address
First Line	:	6079 N FRESNO ST
Second Line	:	STE 105
City	:	FRESNO
State	:	CA
Zip	:	93710-5276
Country	:	US
Telephone Number	:	559-222-7001
Fax Number	:	559-222-7087

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	06/20/2008

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