Provider Demographics
NPI:1700098241
Name:CROSSWAY FAMILY DENTAL PA
Entity Type:Organization
Organization Name:CROSSWAY FAMILY DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:IM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-743-8701
Mailing Address - Street 1:10 MARKET SQUARE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:SOUTH PARIS
Mailing Address - State:ME
Mailing Address - Zip Code:04281
Mailing Address - Country:US
Mailing Address - Phone:207-743-8701
Mailing Address - Fax:207-743-2787
Practice Address - Street 1:10 MARKET SQUARE
Practice Address - Street 2:SUITE #3
Practice Address - City:SOUTH PARIS
Practice Address - State:ME
Practice Address - Zip Code:04281
Practice Address - Country:US
Practice Address - Phone:207-743-8701
Practice Address - Fax:207-743-2787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty