Provider Demographics
NPI:1346295912
Name:CROWDER, RICHARD E (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:CROWDER
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 1:7015 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1943
Mailing Address - Country:US
Mailing Address - Phone:316-684-5184
Mailing Address - Fax:316-684-5197
Practice Address - Street 1:7015 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1943
Practice Address - Country:US
Practice Address - Phone:316-684-5184
Practice Address - Fax:316-684-5197
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS49921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics