Provider Demographics
NPI:1326053729
Name:CROWLEY, MAURICE R (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:R
Last Name:CROWLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1919 STATE ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4929
Mailing Address - Country:US
Mailing Address - Phone:812-945-2760
Mailing Address - Fax:812-945-2780
Practice Address - Street 1:1919 STATE ST
Practice Address - Street 2:SUITE 402
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4929
Practice Address - Country:US
Practice Address - Phone:812-945-2760
Practice Address - Fax:812-945-2780
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1200-82211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100115950AMedicaid
IN300058496OtherTAX ID
IN300058496OtherTAX ID