MEDICARE: DR. WILLIAM EDWARD CROOKS D.M.D.

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	1223P0300X	Periodontics	DN7562	FL

General Provider Information

NPI Number	:	1467488478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM EDWARD CROOKS D.M.D.

Provider Business Mailing Address
First Line	:	4175 S ALAMO AVENUE
Second Line	:	355TH MEDICAL GROUP
City	:	DAVIS-MONTHAN AFB
State	:	AZ
Zip	:	85707
Country	:	US
Telephone Number	:	520-228-2722
Fax Number	:

Provider Business Practice Location Address
First Line	:	4175 S ALAMO AVE
Second Line	:
City	:	DAVIS MONTHAN A F B
State	:	AZ
Zip	:	85707-6097
Country	:	US
Telephone Number	:	520-228-2651
Fax Number	:

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	11/28/2007

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