Provider Demographics
NPI:1912152034
Name:CROSBY, TRICIA R (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:R
Last Name:CROSBY
Suffix:
Gender:F
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 TYLER RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-3305
Mailing Address - Country:US
Mailing Address - Phone:630-377-4677
Mailing Address - Fax:630-377-5025
Practice Address - Street 1:525 TYLER RD
Practice Address - Street 2:SUITE E
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-3305
Practice Address - Country:US
Practice Address - Phone:630-377-4677
Practice Address - Fax:630-377-5025
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0264791223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics