Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 8287 | NC |
N | 1223G0001X | General Practice | 14726 | FL |
N | 213EG0000X | General Practice | 14726 | FL |
Y | 1223G0001X | General Practice | 8287 | NC |
Y | 213EG0000X | General Practice | 8287 | NC |
NPI | 1609910629 |
---|---|
Provider Name | Dr. Candace Crowe |
First Address | Kannapolis, NC 28081-5924 |
Second Address | Kannapolis, NC 28081-5924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 22/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14726 | FLORIDA DENTAL LICENSE (01) | FL |
5905149 | (05) | NC |
8287 | NC DENTAL LICENSE (01) | NC |