Provider Demographics
NPI:1164838454
Name:CRONAUER, EDWARD ANTHONY IV (DMD, MDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ANTHONY
Last Name:CRONAUER
Suffix:IV
Gender:M
Credentials:DMD, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-3716
Mailing Address - Country:US
Mailing Address - Phone:863-983-5121
Mailing Address - Fax:
Practice Address - Street 1:327 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3716
Practice Address - Country:US
Practice Address - Phone:863-983-5121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN206171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics