Provider Demographics
NPI:1407860141
Name:CROWDER, RICHARD DONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DONALD
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 1:15520 W 89TH ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1166
Mailing Address - Country:US
Mailing Address - Phone:913-599-0058
Mailing Address - Fax:
Practice Address - Street 1:14922 W 87TH STREET PKWY
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-4159
Practice Address - Country:US
Practice Address - Phone:913-563-5893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS604301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice