Provider Demographics
NPI:1750466603
Name:CROSLAND, EMMET CRAIG (DMD)
Entity Type:Individual
Prefix:DR
First Name:EMMET
Middle Name:CRAIG
Last Name:CROSLAND
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 1:618 BRIARWOOD DR
Mailing Address - Street 2:#F
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-2665
Mailing Address - Country:US
Mailing Address - Phone:601-956-7828
Mailing Address - Fax:
Practice Address - Street 1:618 BRIARWOOD DR
Practice Address - Street 2:#F
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-2665
Practice Address - Country:US
Practice Address - Phone:601-956-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2262-861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice