Healthcare Provider Details

I. General information

NPI: 1316911340
Provider Name (Legal Business Name): TODD E CROWLEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 BILLINGSLEY RD SUITE 105
CHARLOTTE NC
28211-1066
US

IV. Provider business mailing address

411 BILLINGSLEY RD SUITE 105
CHARLOTTE NC
28211-1066
US

V. Phone/Fax

Practice location:
  • Phone: 704-347-3900
  • Fax: 704-347-0133
Mailing address:
  • Phone: 704-347-3900
  • Fax: 704-347-0133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5802
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: