Provider Demographics
NPI:1356501530
Name:CRESCO FAMILY DENTISTRY, P.C.
Entity Type:Organization
Organization Name:CRESCO FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAW
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:5635-472-3212
Mailing Address - Street 1:PO BOX 201
Mailing Address - Street 2:
Mailing Address - City:CRESCO
Mailing Address - State:IA
Mailing Address - Zip Code:52136-0201
Mailing Address - Country:US
Mailing Address - Phone:563-547-2312
Mailing Address - Fax:
Practice Address - Street 1:210 N ELM ST
Practice Address - Street 2:
Practice Address - City:CRESCO
Practice Address - State:IA
Practice Address - Zip Code:52136-1522
Practice Address - Country:US
Practice Address - Phone:563-547-2312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA71671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty