MEDICARE: DR. CORRIE JEAN CROWE 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	DS037676	PA
2	1223G0001X	General Practice Dentistry	DI02368000	NJ

General Provider Information

NPI Number	:	1407881113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORRIE JEAN CROWE DDS

Provider Business Mailing Address
First Line	:	24 SANDPIPER DR
Second Line	:
City	:	VOORHEES
State	:	NJ
Zip	:	08043-1617
Country	:	US
Telephone Number	:	215-898-8965
Fax Number	:	215-573-4090

Provider Business Practice Location Address
First Line	:	240 S 40TH ST STE 916
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-6030
Country	:	US
Telephone Number	:	215-898-8965
Fax Number	:	215-573-4090

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	03/18/2024

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