Provider Demographics
NPI:1306017553
Name:CROWDER, EBONY CHERIE (RDH)
Entity Type:Individual
Prefix:MISS
First Name:EBONY
Middle Name:CHERIE
Last Name:CROWDER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MARLIN DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-1112
Mailing Address - Country:US
Mailing Address - Phone:203-515-6558
Mailing Address - Fax:
Practice Address - Street 1:135 BANK ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-2205
Practice Address - Country:US
Practice Address - Phone:203-755-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007236124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist