Provider Demographics
NPI:1235763830
Name:CREW, MICHAEL JEFFREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JEFFREY
Last Name:CREW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 18TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-2725
Mailing Address - Country:US
Mailing Address - Phone:712-240-6521
Mailing Address - Fax:
Practice Address - Street 1:806 S DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6823
Practice Address - Country:US
Practice Address - Phone:712-240-6521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-09729122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist