MEDICARE: DR. GARY S CROSSON DMD

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	DN0008852	FL

General Provider Information

NPI Number	:	1265440028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY S CROSSON DMD

Provider Business Mailing Address
First Line	:	362 HIGHWAY 83 N
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32433-3800
Country	:	US
Telephone Number	:	850-892-8015
Fax Number	:	850-892-8024

Provider Business Practice Location Address
First Line	:	362 STATE HIGHWAY 83
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32433-3800
Country	:	US
Telephone Number	:	850-892-8015
Fax Number	:	850-892-8024

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	03/01/2012

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