MEDICARE: MRS. MARY CECILIA CROSBY 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN0011236	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194761213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY CECILIA CROSBY DDS

Provider Business Mailing Address
First Line	:	4300 SW 92 AVE
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33328
Country	:	US
Telephone Number	:	954-424-1965
Fax Number	:

Provider Business Practice Location Address
First Line	:	5607 NW 27TH AVE STE 2
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-2826
Country	:	US
Telephone Number	:	305-376-6400
Fax Number	:	305-636-5155

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	05/19/2022

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