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General NPI Number Information
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NPI Number | 1881883429
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Entity Type | Organization
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Legal Business Name | CHARLES N CROWDER DMD PC
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 334 JOHN D ODOM RD
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City | DOTHAN
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State | AL
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Zip | 36303-9479
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Country | US
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Telephone | 334-792-5124
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Fax | 334-793-2049
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Provider Business Mailing Address
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Address Line | 334 JOHN D ODOM RD
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City | DOTHAN
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State | AL
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Zip | 36303-9479
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Country | US
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Telephone | 334-792-5124
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Fax | 334-793-2049
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES NEWTON CROWDER
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Credential | DMD MPH MS
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Telephone | 334-792-5124
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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 | 5203
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License Number State | AL
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