Healthcare Provider Details

I. General information

NPI: 1013042050
Provider Name (Legal Business Name): KEVIN EDMOND CRESCI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 ROUTE 22 STE 1
DOVER PLAINS NY
12522-5935
US

IV. Provider business mailing address

644 OLD STATE ROUTE 22
DOVER PLAINS NY
12522-5822
US

V. Phone/Fax

Practice location:
  • Phone: 845-877-9294
  • Fax:
Mailing address:
  • Phone: 845-832-6325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0358741
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: