Provider Demographics
NPI:1104804921
Name:CROW, STEWART L (DDS PA)
Entity type:Individual
Prefix:DR
First Name:STEWART
Middle Name:L
Last Name:CROW
Suffix:
Gender:M
Credentials:DDS PA
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 648
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-0648
Mailing Address - Country:US
Mailing Address - Phone:620-331-4859
Mailing Address - Fax:620-331-4863
Practice Address - Street 1:117 N PENN AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-3523
Practice Address - Country:US
Practice Address - Phone:620-331-4859
Practice Address - Fax:620-331-4863
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS52361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice