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General NPI Number Information
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NPI Number | 1699115253
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Entity Type | Organization
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Legal Business Name | CROWN HILL DENTISTRY LLC
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Dates
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Enumeration Date | 06/27/2013
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 1792 E STATE HIGHWAY 163
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City | CLINTON
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State | IN
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Zip | 47842-0160
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Country | US
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Telephone | 765-832-7741
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Fax | 765-832-7743
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Provider Business Mailing Address
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Address Line | 1792 E STATE ROAD 163 PO BOX 408
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City | CLINTON
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State | IN
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Zip | 47842-7327
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Country | US
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Telephone | 765-832-7741
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Fax | 765-832-7743
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. GEORGE THOMAS CLOYD
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Credential | DDS
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Telephone | 765-832-7741
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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 | 12006928A
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License Number State | IN
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