Provider Demographics
NPI:1205268711
Name:MAURICE R CROWLEY DMD LLC
Entity type:Organization
Organization Name:MAURICE R CROWLEY DMD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CREAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-945-2760
Mailing Address - Street 1:1919 STATE ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4953
Mailing Address - Country:US
Mailing Address - Phone:812-945-2760
Mailing Address - Fax:812-945-2780
Practice Address - Street 1:1919 STATE ST
Practice Address - Street 2:SUITE 402
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4953
Practice Address - Country:US
Practice Address - Phone:812-945-2760
Practice Address - Fax:812-945-2780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120082211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100115950AMedicaid
INU26207Medicare UPIN