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General NPI Number Information
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NPI Number | 1124757554
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Entity Type | Individual
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Provider Name | WYATT ALLEN CROWELL DDS
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Gender | Male
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 9305 MARKET SQUARE DR
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City | STREETSBORO
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State | OH
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Zip | 44241-5294
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Country | US
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Telephone | 330-422-0011
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Fax |
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Provider Business Mailing Address
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Address Line | 2630 BISSONNET ST APT 3143
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City | HOUSTON
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State | TX
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Zip | 77005-1365
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Country | US
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Telephone | 614-557-8483
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 38505
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License Number State | TX
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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 | 30.027244
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License Number State | OH
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