Provider Demographics
NPI:1245293869
Name:CROSBY, KENNETH OWEN II (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:OWEN
Last Name:CROSBY
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:6079 N FRESNO ST
Mailing Address - Street 2:STE 105
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5276
Mailing Address - Country:US
Mailing Address - Phone:559-222-7001
Mailing Address - Fax:559-222-7087
Practice Address - Street 1:6079 N FRESNO ST
Practice Address - Street 2:STE 105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5276
Practice Address - Country:US
Practice Address - Phone:559-222-7001
Practice Address - Fax:559-222-7087
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2008-06-20
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Provider Licenses
StateLicense IDTaxonomies
CA334471223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0221XDental ProvidersDentistPediatric Dentistry