Provider Demographics
NPI:1639224512
Name:CROOKS, EDWIN LW (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:LW
Last Name:CROOKS
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 1:1206 YORK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6217
Mailing Address - Country:US
Mailing Address - Phone:410-337-8940
Mailing Address - Fax:410-337-8994
Practice Address - Street 1:1206 YORK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6217
Practice Address - Country:US
Practice Address - Phone:410-337-8940
Practice Address - Fax:410-337-8994
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD055141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice