Provider Demographics
NPI:1396903811
Name:JOHN W. CROWDER, D.D.S.,P.C.
Entity type:Organization
Organization Name:JOHN W. CROWDER, D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CROWDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:731-660-7799
Mailing Address - Street 1:209 OIL WELL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-7924
Mailing Address - Country:US
Mailing Address - Phone:731-660-7799
Mailing Address - Fax:731-660-4450
Practice Address - Street 1:209 OIL WELL RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-7924
Practice Address - Country:US
Practice Address - Phone:731-660-7799
Practice Address - Fax:731-660-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4312261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental