Provider Demographics
NPI:1124536917
Name:CROWDER, CHARLES N (DMD, MPH, MS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:N
Last Name:CROWDER
Suffix:
Gender:M
Credentials:DMD, MPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 JOHN D ODOM RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-9479
Mailing Address - Country:US
Mailing Address - Phone:334-792-5124
Mailing Address - Fax:
Practice Address - Street 1:334 JOHN D ODOM RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-9479
Practice Address - Country:US
Practice Address - Phone:334-792-5124
Practice Address - Fax:334-793-2049
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL52031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics