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General NPI Number Information
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NPI Number | 1871620419
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Entity Type | Organization
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Legal Business Name | ANDREW E. CROW, D.D.S., S.C.
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 508 VINCENT ST # A
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City | STEVENS POINT
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State | WI
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Zip | 54481-1848
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Country | US
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Telephone | 715-344-6390
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Fax | 715-344-9888
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Provider Business Mailing Address
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Address Line | 508 VINCENT ST # A
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City | STEVENS POINT
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State | WI
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Zip | 54481-1848
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Country | US
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Telephone | 715-344-6390
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Fax | 715-344-9888
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREW EARL CROW
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Credential | D.D.S.
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Telephone | 715-344-6390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5607-015
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License Number State | WI
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