Provider Demographics
NPI:1992831705
Name:CROWLEY, COULTER TIMOTHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:COULTER
Middle Name:TIMOTHY
Last Name:CROWLEY
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 1:61 AVENIDA LAS PALMAS
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4677
Mailing Address - Country:US
Mailing Address - Phone:760-837-1983
Mailing Address - Fax:760-346-9413
Practice Address - Street 1:61 AVENIDA LAS PALMAS
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4677
Practice Address - Country:US
Practice Address - Phone:760-837-1983
Practice Address - Fax:760-346-9413
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA392491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice