Provider Demographics
NPI:1265480875
Name:CROWTHER, JAMES T (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:T
Last Name:CROWTHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 E GRAVES AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-5269
Mailing Address - Country:US
Mailing Address - Phone:386-775-4300
Mailing Address - Fax:386-775-0630
Practice Address - Street 1:272 E GRAVES AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-5269
Practice Address - Country:US
Practice Address - Phone:386-775-4300
Practice Address - Fax:386-775-0630
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 0091831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN9183OtherSTATE LICENSE
AC1727354OtherDEA
AC1727354OtherDEA
FLDN9183OtherSTATE LICENSE