Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 19025 | OH |
NPI | 1083892897 |
---|---|
Provider Name | Dr. Carolyn B Crowell |
First Address | Avon, OH 44011-4059 |
Second Address | Avon, OH 44011-4059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2008 |
Last Update Date | 04/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0748856 | (05) | OH |