Healthcare Provider Details

I. General information

NPI: 1194761213
Provider Name (Legal Business Name): MARY CECILIA CROSBY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: M CECILIA CROSBY-EL-AMIN DDS PA

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5607 NW 27TH AVE STE 2
MIAMI FL
33142-2826
US

IV. Provider business mailing address

4300 SW 92 AVE
DAVIE FL
33328
US

V. Phone/Fax

Practice location:
  • Phone: 305-376-6400
  • Fax: 305-636-5155
Mailing address:
  • Phone: 954-424-1965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN0011236
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: