Provider Demographics
NPI:1588227516
Name:CROSBY, VERONICA (CDA)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:CROSBY
Suffix:
Gender:F
Credentials:CDA
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:L
Other - Last Name:ELIAS GALLARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDA
Mailing Address - Street 1:314 UNION STATION DR
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-4547
Mailing Address - Country:US
Mailing Address - Phone:864-482-7900
Mailing Address - Fax:
Practice Address - Street 1:314 UNION STATION DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-4547
Practice Address - Country:US
Practice Address - Phone:864-482-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC218412126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant