Provider Demographics
NPI:1891216461
Name:CROUSE, CORY LAWRENCE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:LAWRENCE
Last Name:CROUSE
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 1:1182 AUKELE ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3616
Mailing Address - Country:US
Mailing Address - Phone:402-203-6777
Mailing Address - Fax:
Practice Address - Street 1:94-050 FARRINGTON HWY STE E1-2
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1842
Practice Address - Country:US
Practice Address - Phone:808-677-2451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-27041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice