Provider Demographics
NPI:1104873066
Name:FINNEGAN, CRYSTAL CREW (DDS)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:CREW
Last Name:FINNEGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11180 E FINCH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:NC
Mailing Address - Zip Code:27557-7440
Mailing Address - Country:US
Mailing Address - Phone:252-235-0491
Mailing Address - Fax:252-235-0497
Practice Address - Street 1:11180 E FINCH AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NC
Practice Address - Zip Code:27557-7440
Practice Address - Country:US
Practice Address - Phone:252-235-0491
Practice Address - Fax:252-235-0497
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6023122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5919175Medicaid