Provider Demographics
NPI:1801922877
Name:BETSY A CROSSWELL DMD
Entity type:Organization
Organization Name:BETSY A CROSSWELL DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CROSSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-346-2470
Mailing Address - Street 1:195 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3760
Mailing Address - Country:US
Mailing Address - Phone:860-346-2470
Mailing Address - Fax:860-704-0072
Practice Address - Street 1:195 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3760
Practice Address - Country:US
Practice Address - Phone:860-346-2470
Practice Address - Fax:860-704-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT70241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty