MEDICARE: DR. TRICIA R CROSBY DDS,MS

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	019.026479	IL

General Provider Information

NPI Number	:	1912152034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRICIA R CROSBY DDS,MS

Provider Business Mailing Address
First Line	:	525 TYLER RD
Second Line	:	SUITE E
City	:	ST CHARLES
State	:	IL
Zip	:	60174-3305
Country	:	US
Telephone Number	:	630-377-4677
Fax Number	:	630-377-5025

Provider Business Practice Location Address
First Line	:	525 TYLER RD
Second Line	:	SUITE E
City	:	ST CHARLES
State	:	IL
Zip	:	60174-3305
Country	:	US
Telephone Number	:	630-377-4677
Fax Number	:	630-377-5025

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

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	11/18/2008

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