Provider Demographics
NPI:1023227428
Name:CROWDER, JOHN RANDALL (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RANDALL
Last Name:CROWDER
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:PO BOX 2569
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38557
Mailing Address - Country:US
Mailing Address - Phone:931-484-9495
Mailing Address - Fax:931-484-9450
Practice Address - Street 1:2623 HWY 70 EAST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555
Practice Address - Country:US
Practice Address - Phone:931-484-9495
Practice Address - Fax:931-484-9450
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND4797122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist