Provider Demographics
NPI:1831298769
Name:CROWL, CHARLES E (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:CROWL
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 1:3801 S HURSTBOURNE PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-7319
Mailing Address - Country:US
Mailing Address - Phone:502-709-9430
Mailing Address - Fax:
Practice Address - Street 1:3801 S HURSTBOURNE PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-7319
Practice Address - Country:US
Practice Address - Phone:502-709-9430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-020700122300000X
KY9811122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist