Provider Demographics
NPI:1689779571
Name:CREWS II, JAMES P (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:CREWS II
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2200 E PARRISH AVE STE 202C
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1451
Mailing Address - Country:US
Mailing Address - Phone:270-683-7447
Mailing Address - Fax:270-852-1625
Practice Address - Street 1:2200 E PARRISH AVE STE 202C
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1451
Practice Address - Country:US
Practice Address - Phone:270-683-7447
Practice Address - Fax:270-852-1625
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY77481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60002078Medicaid