Provider Demographics
NPI:1477217693
Name:CRONIN DENTISTRY OF COLUMBIA
Entity Type:Organization
Organization Name:CRONIN DENTISTRY OF COLUMBIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:CRONIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-736-1761
Mailing Address - Street 1:440 BROAD ST.
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429
Mailing Address - Country:US
Mailing Address - Phone:601-736-1761
Mailing Address - Fax:601-736-1766
Practice Address - Street 1:440 BROAD ST.
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429
Practice Address - Country:US
Practice Address - Phone:601-736-1761
Practice Address - Fax:601-736-1766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty