Provider Demographics
NPI:1609910629
Name:CROWE, CANDACE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:
Last Name:CROWE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-5924
Mailing Address - Country:US
Mailing Address - Phone:704-932-5000
Mailing Address - Fax:704-932-5006
Practice Address - Street 1:1706 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081-5924
Practice Address - Country:US
Practice Address - Phone:704-932-5000
Practice Address - Fax:704-932-5006
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC82871223D0001X, 1223G0001X
FL147261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8287OtherNC DENTAL LICENSE
NC5905149Medicaid
FL14726OtherFLORIDA DENTAL LICENSE