Provider Demographics
NPI:1023208766
Name:CROMWELL, JUSTIN THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:THOMAS
Last Name:CROMWELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 COLEMANS XING
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-7129
Mailing Address - Country:US
Mailing Address - Phone:937-738-7610
Mailing Address - Fax:937-738-7614
Practice Address - Street 1:450 COLEMANS XING
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-7129
Practice Address - Country:US
Practice Address - Phone:937-738-7610
Practice Address - Fax:937-738-7614
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.022556122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist