Healthcare Provider Details

I. General information

NPI: 1982711537
Provider Name (Legal Business Name): THOMAS ROSS CROMWELL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N. MAIN
WEST UNITY OH
43570-0407
US

IV. Provider business mailing address

PO BOX 407
WEST UNITY OH
43570-0407
US

V. Phone/Fax

Practice location:
  • Phone: 419-924-2615
  • Fax:
Mailing address:
  • Phone: 419-924-2615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-01-4277
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: