Provider Demographics
NPI:1376640391
Name:CROWTHER, LANCE DAVID (DDS PC)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:DAVID
Last Name:CROWTHER
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-0721
Mailing Address - Country:US
Mailing Address - Phone:801-829-6471
Mailing Address - Fax:801-829-6475
Practice Address - Street 1:195 E 100 N
Practice Address - Street 2:
Practice Address - City:MORGAN
Practice Address - State:UT
Practice Address - Zip Code:84050-0721
Practice Address - Country:US
Practice Address - Phone:801-829-6471
Practice Address - Fax:801-829-6475
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5129696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist