Healthcare Provider Details

I. General information

NPI: 1477605368
Provider Name (Legal Business Name): NATHANIEL DAVID CROW MS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S DIVISION AVE
SANDPOINT ID
83864-2737
US

IV. Provider business mailing address

301 S DIVISION AVE
SANDPOINT ID
83864-2737
US

V. Phone/Fax

Practice location:
  • Phone: 208-773-1860
  • Fax:
Mailing address:
  • Phone: 208-773-1860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD1772OR
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: