Provider Demographics
NPI:1265720320
Name:CROWDER FAMILY DENTAL CARE, PC
Entity type:Organization
Organization Name:CROWDER FAMILY DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWDER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:731-635-5000
Mailing Address - Street 1:1800 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-5598
Mailing Address - Country:US
Mailing Address - Phone:731-635-5000
Mailing Address - Fax:731-635-7540
Practice Address - Street 1:1800 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063-5598
Practice Address - Country:US
Practice Address - Phone:731-635-5000
Practice Address - Fax:731-635-7540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS4048122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty