MEDICARE: CROSSLEY DENTAL ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D23947	NY
2	1223G0001X	General Practice Dentistry	047466-1	NY

General Provider Information

NPI Number	:	1023376282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSLEY DENTAL ASSOCIATES PC

Provider Business Mailing Address
First Line	:	145 CLINTON STREET
Second Line	:	SUITE 112
City	:	WATERTOWN
State	:	NY
Zip	:	13601-3664
Country	:	US
Telephone Number	:	315-788-3240
Fax Number	:	315-788-1279

Provider Business Practice Location Address
First Line	:	145 CLINTON STREET
Second Line	:	SUITE 112
City	:	WATERTOWN
State	:	NY
Zip	:	13601-3664
Country	:	US
Telephone Number	:	315-788-3240
Fax Number	:	315-788-1279

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANDREW E.C. CROSSLEY
Credential	:	DMD
Telephone Number	:	315-788-3240

Provider Enumeration Date	:	04/25/2012
Last Update Date	:	04/25/2012

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