Provider Demographics
NPI:1982711537
Name:CROMWELL, THOMAS ROSS (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ROSS
Last Name:CROMWELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:WEST UNITY
Mailing Address - State:OH
Mailing Address - Zip Code:43570-0407
Mailing Address - Country:US
Mailing Address - Phone:419-924-2615
Mailing Address - Fax:
Practice Address - Street 1:105 N. MAIN
Practice Address - Street 2:
Practice Address - City:WEST UNITY
Practice Address - State:OH
Practice Address - Zip Code:43570-0407
Practice Address - Country:US
Practice Address - Phone:419-924-2615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-42771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice