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General NPI Number Information
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NPI Number | 1922423078
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Entity Type | Organization
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Legal Business Name | CROWLEY FAMILY DENTAL CENTER
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Dates
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Enumeration Date | 02/26/2014
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Last Update Date | 02/26/2014
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Provider Practice Location Address
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Address Line | 779 FM 1187 E
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City | CROWLEY
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State | TX
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Zip | 76036-4346
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Country | US
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Telephone | 807-297-0058
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Fax | 817-297-7811
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Provider Business Mailing Address
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Address Line | 779 FM 1187 E
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City | CROWLEY
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State | TX
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Zip | 76036-4346
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Country | US
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Telephone | 807-297-0058
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Fax | 817-297-7811
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ODALIS PATRICIA SKUR
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Credential | DDS
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Telephone | 817-297-0058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 20899
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License Number State | TX
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