1487705208 NPI number — JODY L. CROWL, D.D.S.

Table of content: (NPI 1487705208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487705208 NPI number — JODY L. CROWL, D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JODY L. CROWL, D.D.S.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487705208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 338
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59044-0338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-628-8741
Provider Business Mailing Address Fax Number:
406-628-8741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59044-3106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-628-8741
Provider Business Practice Location Address Fax Number:
406-628-8741
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CROWL
Authorized Official First Name:
JODY
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
406-628-8741

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  1965 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0111670 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5510839 . This is a "BLUE CHIP" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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