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General NPI Number Information
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NPI Number | 1912152034
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Entity Type | Individual
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Provider Name | TRICIA R CROSBY DDS,MS
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Gender | Female
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Dates
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Enumeration Date | 11/18/2008
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 525 TYLER RD SUITE E
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City | ST CHARLES
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State | IL
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Zip | 60174-3305
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Country | US
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Telephone | 630-377-4677
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Fax | 630-377-5025
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Provider Business Mailing Address
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Address Line | 525 TYLER RD SUITE E
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City | ST CHARLES
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State | IL
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Zip | 60174-3305
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Country | US
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Telephone | 630-377-4677
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Fax | 630-377-5025
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 019.026479
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License Number State | IL
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