Provider Demographics
NPI:1194198325
Name:AMY ELIZABETH CRARY DMD PA
Entity Type:Organization
Organization Name:AMY ELIZABETH CRARY DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CRARY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:772-463-4026
Mailing Address - Street 1:931 SE OCEAN BLVD
Mailing Address - Street 2:SUITE B1
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2425
Mailing Address - Country:US
Mailing Address - Phone:772-463-4026
Mailing Address - Fax:772-463-4452
Practice Address - Street 1:931 SE OCEAN BLVD
Practice Address - Street 2:SUITE B1
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2425
Practice Address - Country:US
Practice Address - Phone:772-463-4026
Practice Address - Fax:772-463-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15951122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty