Provider Demographics
NPI:1770794612
Name:JOHN E. CROSLAND DDS
Entity type:Organization
Organization Name:JOHN E. CROSLAND DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:CROSLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-484-0148
Mailing Address - Street 1:901-A NORTH LAFAYETTE ST.
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150
Mailing Address - Country:US
Mailing Address - Phone:704-484-0148
Mailing Address - Fax:704-484-0148
Practice Address - Street 1:901 N LAFAYETTE ST
Practice Address - Street 2:SUITE A
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3832
Practice Address - Country:US
Practice Address - Phone:704-484-0148
Practice Address - Fax:704-484-0148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC48911223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC91901OtherBCBS
1245313600OtherINDIVIDUAL NPI ENUMERATOR
NC91901OtherBCBS
NCT63848Medicare UPIN