Healthcare Provider Details

I. General information

NPI: 1205268711
Provider Name (Legal Business Name): MAURICE R CROWLEY DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 STATE ST SUITE 402
NEW ALBANY IN
47150-4953
US

IV. Provider business mailing address

1919 STATE ST SUITE 402
NEW ALBANY IN
47150-4953
US

V. Phone/Fax

Practice location:
  • Phone: 812-945-2760
  • Fax: 812-945-2780
Mailing address:
  • Phone: 812-945-2760
  • Fax: 812-945-2780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12008221
License Number StateIN

VIII. Authorized Official

Name: MRS. TAMARA CREAMER
Title or Position: OFFICE MANAGER
Credential:
Phone: 812-945-2760