Healthcare Provider Details

I. General information

NPI: 1457533325
Provider Name (Legal Business Name): JAMES M. CROUSE, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 WESLEY DR
SALISBURY MD
21801-7130
US

IV. Provider business mailing address

1413 WESLEY DR
SALISBURY MD
21801-7130
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-2933
  • Fax: 410-749-0239
Mailing address:
  • Phone: 410-749-2933
  • Fax: 410-749-0239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8944
License Number StateMD

VIII. Authorized Official

Name: DR. JAMES MICHAEL CROUSE
Title or Position: OWNER/ORTHODONTIST
Credential: DDS, PA
Phone: 410-749-2933