MEDICARE: RICHARD W CROWLEY DDS

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	122300000X	Dentist	22D101204100	NJ

General Provider Information

NPI Number	:	1154473866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD W CROWLEY DDS

Provider Business Mailing Address
First Line	:	566 MT PROSPECT AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07104-1530
Country	:	US
Telephone Number	:	973-485-5334
Fax Number	:	973-484-9561

Provider Business Practice Location Address
First Line	:	566 MT PROSPECT AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07104-1530
Country	:	US
Telephone Number	:	973-485-5334
Fax Number	:	973-484-9561

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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