=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346624566
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICTORIA CROW DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2015
-----------------------------------------------------
Last Update Date | 09/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 259 METRO DR
-----------------------------------------------------
City | WARRINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-406-5444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 530
-----------------------------------------------------
City | PRIMOS SECANE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19018-0530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-400-8593
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DS040400
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------