Provider Demographics
NPI:1912629007
Name:CORY L CROUSE DMD LLC
Entity Type:Organization
Organization Name:CORY L CROUSE DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:402-203-6777
Mailing Address - Street 1:1182 AUKELE ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3616
Mailing Address - Country:US
Mailing Address - Phone:402-203-6777
Mailing Address - Fax:
Practice Address - Street 1:99-128 AIEA HEIGHTS DR STE 603
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3939
Practice Address - Country:US
Practice Address - Phone:808-487-3033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental