Provider Demographics
NPI:1023376282
Name:CROSSLEY DENTAL ASSOCIATES PC
Entity Type:Organization
Organization Name:CROSSLEY DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:EC
Authorized Official - Last Name:CROSSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:315-788-3240
Mailing Address - Street 1:145 CLINTON STREET
Mailing Address - Street 2:SUITE 112
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3664
Mailing Address - Country:US
Mailing Address - Phone:315-788-3240
Mailing Address - Fax:315-788-1279
Practice Address - Street 1:145 CLINTON STREET
Practice Address - Street 2:SUITE 112
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3664
Practice Address - Country:US
Practice Address - Phone:315-788-3240
Practice Address - Fax:315-788-1279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047466-11223G0001X
NYD239471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty