Provider Demographics
NPI:1124025622
Name:CROWLEY, KATHLEEN LYNNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:LYNNE
Last Name:CROWLEY
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 1:18001 N 79TH AVE
Mailing Address - Street 2:STE. B16
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8388
Mailing Address - Country:US
Mailing Address - Phone:623-486-9333
Mailing Address - Fax:623-486-9337
Practice Address - Street 1:18001 N 79TH AVE
Practice Address - Street 2:STE. B16
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8388
Practice Address - Country:US
Practice Address - Phone:623-486-9333
Practice Address - Fax:623-486-9337
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice