Provider Demographics
NPI:1295932192
Name:CROWLEY, MICHAEL BRADLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRADLEY
Last Name:CROWLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 N 21ST DR # C-106
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4941
Mailing Address - Country:US
Mailing Address - Phone:602-791-0064
Mailing Address - Fax:
Practice Address - Street 1:18001 N 79TH AVE STE B16
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8390
Practice Address - Country:US
Practice Address - Phone:623-486-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7307122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist