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General NPI Number Information
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NPI Number | 1265720320
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Entity Type | Organization
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Legal Business Name | CROWDER FAMILY DENTAL CARE, PC
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Dates
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Enumeration Date | 07/11/2011
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Last Update Date | 07/11/2011
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Provider Practice Location Address
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Address Line | 1800 HIGHWAY 51 S
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City | RIPLEY
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State | TN
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Zip | 38063-5598
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Country | US
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Telephone | 731-635-5000
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Fax | 731-635-7540
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Provider Business Mailing Address
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Address Line | 1800 HIGHWAY 51 S
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City | RIPLEY
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State | TN
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Zip | 38063-5598
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Country | US
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Telephone | 731-635-5000
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Fax | 731-635-7540
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROY CROWDER JR.
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Credential | DDS
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Telephone | 731-635-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS4048
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License Number State | TN
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