Provider Demographics
NPI:1649392499
Name:MICHAEL H CROWLEY DDS PS
Entity Type:Organization
Organization Name:MICHAEL H CROWLEY DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:CROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PS
Authorized Official - Phone:360-734-6728
Mailing Address - Street 1:3400 SQUALICUM PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1933
Mailing Address - Country:US
Mailing Address - Phone:360-734-6728
Mailing Address - Fax:360-756-8970
Practice Address - Street 1:3400 SQUALICUM PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1933
Practice Address - Country:US
Practice Address - Phone:360-734-6728
Practice Address - Fax:360-756-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA58211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5083100Medicaid
WA86382OtherLABOR & INDUSTRIES
WA86382OtherLABOR & INDUSTRIES