MEDICARE: MR. ROBERT EARL CROSSER JR. 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	12278	TX

General Provider Information

NPI Number	:	1710050794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT EARL CROSSER JR. DDS

Provider Business Mailing Address
First Line	:	6316 AZLE AVE
Second Line	:	200
City	:	LAKE WORTH
State	:	TX
Zip	:	76135-2452
Country	:	US
Telephone Number	:	817-237-7377
Fax Number	:

Provider Business Practice Location Address
First Line	:	6316 AZLE AVE
Second Line	:	200
City	:	LAKE WORTH
State	:	TX
Zip	:	76135-2452
Country	:	US
Telephone Number	:	817-237-7377
Fax Number	:

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	06/02/2010

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