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General NPI Number Information
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NPI Number | 1497818629
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Entity Type | Organization
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Legal Business Name | BRIAN T. CROSBY DMD PA
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 2154 HARDEN BLVD
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City | LAKELAND
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State | FL
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Zip | 33803-5917
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Country | US
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Telephone | 863-683-8127
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Fax | 863-683-4107
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Provider Business Mailing Address
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Address Line | 2154 HARDEN BLVD
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City | LAKELAND
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State | FL
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Zip | 33803-5917
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Country | US
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Telephone | 863-683-8127
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Fax | 863-683-4107
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN TATE CROSBY
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Credential | DMD
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Telephone | 863-683-8127
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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 | DN0013748
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License Number State | FL
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