Provider Demographics
NPI:1154509057
Name:CROWLEY, ALEXIUS JEROME III (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIUS
Middle Name:JEROME
Last Name:CROWLEY
Suffix:III
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 1:720 OSTERMAN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4339
Mailing Address - Country:US
Mailing Address - Phone:847-945-0444
Mailing Address - Fax:847-945-6179
Practice Address - Street 1:720 OSTERMAN AVE STE 101
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4339
Practice Address - Country:US
Practice Address - Phone:847-945-0444
Practice Address - Fax:847-945-6179
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice