Provider Demographics
NPI:1205642220
Name:LANCE D CROWTHER DDS PC
Entity type:Organization
Organization Name:LANCE D CROWTHER DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-829-6471
Mailing Address - Street 1:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-0721
Mailing Address - Country:US
Mailing Address - Phone:801-829-6471
Mailing Address - Fax:801-829-6475
Practice Address - Street 1:195 E 100 N
Practice Address - Street 2:
Practice Address - City:MORGAN
Practice Address - State:UT
Practice Address - Zip Code:84050-9203
Practice Address - Country:US
Practice Address - Phone:801-829-6471
Practice Address - Fax:801-829-6475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty