Healthcare Provider Details

I. General information

NPI: 1437994837
Provider Name (Legal Business Name): BRANDON ROBERT CROWTHER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR RM D1-85
GAINESVILLE FL
32610-3006
US

IV. Provider business mailing address

1222 NW 3RD AVE
GAINESVILLE FL
32601-4911
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6664
  • Fax:
Mailing address:
  • Phone: 850-842-0773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License NumberDN29164
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: