MEDICARE: MICHAEL L. CROWTON 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	1223G0001X	General Practice Dentistry	4937536	UT

General Provider Information

NPI Number	:	1326299215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL L. CROWTON DDS

Provider Business Mailing Address
First Line	:	448 E 5350 S
Second Line	:	SUITE A
City	:	OGDEN
State	:	UT
Zip	:	84405-6931
Country	:	US
Telephone Number	:	801-479-7870
Fax Number	:	801-479-0606

Provider Business Practice Location Address
First Line	:	448 E 5350 S
Second Line	:	SUITE A
City	:	OGDEN
State	:	UT
Zip	:	84405-6931
Country	:	US
Telephone Number	:	801-479-7870
Fax Number	:	801-479-0606

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. MICHAEL LEE CROWTON
Credential	:	DDS
Telephone Number	:	801-479-7870

Provider Enumeration Date	:	10/09/2008
Last Update Date	:	10/09/2008

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