Provider Demographics
NPI:1497732861
Name:CROWDER, JOHN WALTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WALTON
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 1:39 MURRAY GUARD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3610
Mailing Address - Country:US
Mailing Address - Phone:731-660-7799
Mailing Address - Fax:
Practice Address - Street 1:39 MURRAY GUARD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3610
Practice Address - Country:US
Practice Address - Phone:731-660-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDDS 43121223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery