Provider Demographics
NPI:1083602197
Name:CROWDER, ROY ELTON JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:ELTON
Last Name:CROWDER
Suffix:JR
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 1:1800 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-5598
Mailing Address - Country:US
Mailing Address - Phone:731-635-5000
Mailing Address - Fax:731-635-7540
Practice Address - Street 1:1800 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063-5598
Practice Address - Country:US
Practice Address - Phone:731-635-5000
Practice Address - Fax:731-635-7540
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0040481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice