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General NPI Number Information
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NPI Number | 1154304277
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Entity Type | Individual
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Provider Name | JEFFREY GALE CRENSHAW DMD
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Gender | Male
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 12927 W HIGHWAY 42
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City | PROSPECT
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State | KY
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Zip | 40059-9107
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Country | US
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Telephone | 502-292-1160
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Fax | 502-292-1194
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Provider Business Mailing Address
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Address Line | 12927 W HIGHWAY 42
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City | PROSPECT
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State | KY
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Zip | 40059-9107
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Country | US
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Telephone | 502-292-1160
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Fax | 502-292-1194
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7853
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7853
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License Number State | KY
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