Provider Demographics
NPI:1881883429
Name:CHARLES N CROWDER DMD PC
Entity type:Organization
Organization Name:CHARLES N CROWDER DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:NEWTON
Authorized Official - Last Name:CROWDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MPH MS
Authorized Official - Phone:334-792-5124
Mailing Address - Street 1:334 JOHN D ODOM RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-9479
Mailing Address - Country:US
Mailing Address - Phone:334-792-5124
Mailing Address - Fax:334-793-2049
Practice Address - Street 1:334 JOHN D ODOM RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-9479
Practice Address - Country:US
Practice Address - Phone:334-792-5124
Practice Address - Fax:334-793-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL52031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5203OtherAL LICENSE