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General NPI Number Information
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NPI Number | 1912629007
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Entity Type | Organization
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Legal Business Name | CORY L CROUSE DMD LLC
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Dates
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Enumeration Date | 09/15/2022
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Last Update Date | 09/15/2022
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Provider Practice Location Address
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Address Line | 99-128 AIEA HEIGHTS DR STE 603
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City | AIEA
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State | HI
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Zip | 96701-3939
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Country | US
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Telephone | 808-487-3033
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Fax |
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Provider Business Mailing Address
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Address Line | 1182 AUKELE ST
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City | KAILUA
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State | HI
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Zip | 96734-3616
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Country | US
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Telephone | 402-203-6777
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CORY L CROUSE
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Credential | DMD
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Telephone | 402-203-6777
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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 |
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License Number State |
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