Provider Demographics
NPI:1972742039
Name:CROW, DEAN W (DDS)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:W
Last Name:CROW
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 1:2314 N GRANDVIEW BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1675
Mailing Address - Country:US
Mailing Address - Phone:262-547-5550
Mailing Address - Fax:262-547-5572
Practice Address - Street 1:2314 N. GRANDVIEW BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1675
Practice Address - Country:US
Practice Address - Phone:262-547-5550
Practice Address - Fax:262-547-5572
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5000891-0151223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics