Provider Demographics
NPI:1033328414
Name:CREWS, MICHELLE B (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:B
Last Name:CREWS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 TOWNSHIP AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-8694
Mailing Address - Country:US
Mailing Address - Phone:769-257-0399
Mailing Address - Fax:
Practice Address - Street 1:141 TOWNSHIP AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-8694
Practice Address - Country:US
Practice Address - Phone:769-257-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2014-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3311-04122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist