MEDICARE: DR. MICKEY E. CROSBY DMD

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	247989	MS

General Provider Information

NPI Number	:	1841406311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICKEY E. CROSBY DMD

Provider Business Mailing Address
First Line	:	406 BRIARWOOD DR STE 401
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39206-3063
Country	:	US
Telephone Number	:	601-956-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	406 BRIARWOOD DR STE 401
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39206-3063
Country	:	US
Telephone Number	:	601-956-2000
Fax Number	:

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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