Provider Demographics
NPI:1255463808
Name:A. CROSBY LIVINGSTON, JR., DMD, PA
Entity type:Organization
Organization Name:A. CROSBY LIVINGSTON, JR., DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:CROSBY
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-781-0880
Mailing Address - Street 1:1028 KINLEY RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-9632
Mailing Address - Country:US
Mailing Address - Phone:803-781-0880
Mailing Address - Fax:803-781-3288
Practice Address - Street 1:1028 KINLEY RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-9632
Practice Address - Country:US
Practice Address - Phone:803-781-0880
Practice Address - Fax:803-781-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty