Provider Demographics
NPI:1184219552
Name:MCCRORY, RHONDA MARIE (OROFACIAL MYOLOGIST)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:MARIE
Last Name:MCCRORY
Suffix:
Gender:F
Credentials:OROFACIAL MYOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 2ND ST E
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-7953
Mailing Address - Country:US
Mailing Address - Phone:701-515-1876
Mailing Address - Fax:
Practice Address - Street 1:3323 2ND ST E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-7953
Practice Address - Country:US
Practice Address - Phone:701-793-2873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-07
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND635124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty