MEDICARE: DR. LESLIE DEANNE CROWELL-POWELL DENTIST

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	122300000X	Dentist	2901018875	MI

General Provider Information

NPI Number	:	1588631063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE DEANNE CROWELL-POWELL DENTIST

Provider Business Mailing Address
First Line	:	231 E. GRAND RIVER P.O. BOX 187
Second Line	:
City	:	LAINGSBURG
State	:	MI
Zip	:	48848
Country	:	US
Telephone Number	:	517-651-5029
Fax Number	:

Provider Business Practice Location Address
First Line	:	231 E GRAND RIVER RD # 187
Second Line	:
City	:	LAINGSBURG
State	:	MI
Zip	:	48848-8601
Country	:	US
Telephone Number	:	517-651-5029
Fax Number	:

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

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	12/05/2024

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