Provider Demographics
NPI:1154540110
Name:CROWDER, NELLIE (DDS)
Entity type:Individual
Prefix:DR
First Name:NELLIE
Middle Name:
Last Name:CROWDER
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 1:4185 LUXOR TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-6377
Mailing Address - Country:US
Mailing Address - Phone:434-823-5549
Mailing Address - Fax:434-220-4804
Practice Address - Street 1:1461 GREENBRIER PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1697
Practice Address - Country:US
Practice Address - Phone:434-977-7080
Practice Address - Fax:434-220-4804
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010087551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice