Provider Demographics
NPI:1316193857
Name:CROSSLEY, MICHAEL ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANDREW
Last Name:CROSSLEY
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 1:225 HAMRICK RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-5405
Mailing Address - Country:US
Mailing Address - Phone:303-621-4368
Mailing Address - Fax:478-254-3921
Practice Address - Street 1:1299 RUSSELL PKWY
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5582
Practice Address - Country:US
Practice Address - Phone:478-923-6449
Practice Address - Fax:478-923-2140
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2011-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO96561223G0001X
GADN0136761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice