Provider Demographics
NPI:1033449517
Name:CREWS, IMELDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:IMELDA
Middle Name:
Last Name:CREWS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 TRIBBLE GAP ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040
Mailing Address - Country:US
Mailing Address - Phone:678-341-9101
Mailing Address - Fax:678-771-8925
Practice Address - Street 1:202 TRIBBLE GAP ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040
Practice Address - Country:US
Practice Address - Phone:678-341-9101
Practice Address - Fax:678-771-8925
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0139971223G0001X
GADNO139971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice