Provider Demographics
NPI:1124199500
Name:CROHIN, CONSTANT (DMD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANT
Middle Name:
Last Name:CROHIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 DUFF ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3017
Mailing Address - Country:US
Mailing Address - Phone:617-744-5155
Mailing Address - Fax:617-249-2023
Practice Address - Street 1:212 CHARLES ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-4206
Practice Address - Country:US
Practice Address - Phone:781-894-4424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA194601223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics