Provider Demographics
NPI:1619153376
Name:CROWLEY, PAUL BRIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BRIAN
Last Name:CROWLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ROUTE 94
Mailing Address - Street 2:VIKING VILLAGE,SUITE H
Mailing Address - City:VERNON
Mailing Address - State:NJ
Mailing Address - Zip Code:07462-3553
Mailing Address - Country:US
Mailing Address - Phone:973-827-0234
Mailing Address - Fax:
Practice Address - Street 1:5 ROUTE 94
Practice Address - Street 2:VIKING VILLAGE,SUITE H
Practice Address - City:VERNON
Practice Address - State:NJ
Practice Address - Zip Code:07462-3553
Practice Address - Country:US
Practice Address - Phone:973-827-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI00960000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist