Provider Demographics
NPI:1255341368
Name:CROWLEY, KATHLEEN M (DMD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:M
Other - Last Name:CROWLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:180 ELSBREE STREET
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720
Mailing Address - Country:US
Mailing Address - Phone:617-267-6767
Mailing Address - Fax:
Practice Address - Street 1:180 ELSBREE STREET
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720
Practice Address - Country:US
Practice Address - Phone:508-672-1069
Practice Address - Fax:508-672-3848
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA189341223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics