1881883429 NPI number — CHARLES N CROWDER DMD PC

Table of content: (NPI 1881883429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881883429 NPI number — CHARLES N CROWDER DMD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES N CROWDER DMD PC
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:
CROWDER ORTHODONTICS
Provider Other Organization Name Type Code:
3
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:
1881883429
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
334 JOHN D ODOM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36303-9479
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-792-5124
Provider Business Mailing Address Fax Number:
334-793-2049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
334 JOHN D ODOM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36303-9479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-792-5124
Provider Business Practice Location Address Fax Number:
334-793-2049
Provider Enumeration Date:
10/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CROWDER
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
NEWTON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
334-792-5124

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  5203 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5203 . This is a "AL LICENSE" identifier . This identifiers is of the category "OTHER".




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