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General NPI Number Information
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NPI Number | 1023376282
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Entity Type | Organization
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Legal Business Name | CROSSLEY DENTAL ASSOCIATES PC
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Dates
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Enumeration Date | 04/25/2012
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 145 CLINTON STREET SUITE 112
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City | WATERTOWN
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State | NY
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Zip | 13601-3664
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Country | US
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Telephone | 315-788-3240
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Fax | 315-788-1279
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Provider Business Mailing Address
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Address Line | 145 CLINTON STREET SUITE 112
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City | WATERTOWN
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State | NY
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Zip | 13601-3664
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Country | US
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Telephone | 315-788-3240
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Fax | 315-788-1279
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREW E.C. CROSSLEY
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Credential | DMD
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Telephone | 315-788-3240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D23947
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 047466-1
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License Number State | NY
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