Provider Demographics
NPI:1811056583
Name:CROVATT, MICHAEL LEE (DMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:CROVATT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 EASTLAND BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4104
Mailing Address - Country:US
Mailing Address - Phone:727-791-1450
Mailing Address - Fax:727-791-0149
Practice Address - Street 1:3001 EASTLAND BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4104
Practice Address - Country:US
Practice Address - Phone:727-791-1450
Practice Address - Fax:727-791-0149
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 9579122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist