Provider Demographics
NPI:1477364149
Name:CROWL, TERRISSA BROOKE (DDS)
Entity type:Individual
Prefix:
First Name:TERRISSA
Middle Name:BROOKE
Last Name:CROWL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 FAYETTE CIR N
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-4349
Mailing Address - Country:US
Mailing Address - Phone:681-533-8571
Mailing Address - Fax:
Practice Address - Street 1:1831 N BELCHER RD STE F3
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1453
Practice Address - Country:US
Practice Address - Phone:727-791-8823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29656122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist