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General NPI Number Information
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NPI Number | 1649394180
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Entity Type | Organization
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Legal Business Name | CROWE & MCGUIRE ORTHODONTICS, LLC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1736 BROADWAY ST
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63701-4552
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Country | US
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Telephone | 573-334-5755
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Fax |
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Provider Business Mailing Address
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Address Line | 1736 BROADWAY ST
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63701-4552
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Country | US
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Telephone | 573-334-5755
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MELISSA CROWE
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Credential |
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Telephone | 573-334-5755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12897
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License Number State | MO
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