Provider Demographics
NPI:1225318595
Name:CROSBY, EMILY REBEKAH (DMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:REBEKAH
Last Name:CROSBY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 SANDERS CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-1307
Mailing Address - Country:US
Mailing Address - Phone:315-454-6000
Mailing Address - Fax:
Practice Address - Street 1:8101 NE PARKWAY DR
Practice Address - Street 2:STE F1/F2
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-7911
Practice Address - Country:US
Practice Address - Phone:360-882-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD96081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice