Provider Demographics
NPI:1154983690
Name:CROSBY, WILLIAM JUSTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JUSTIN
Last Name:CROSBY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 HILTON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-6623
Mailing Address - Country:US
Mailing Address - Phone:843-497-3707
Mailing Address - Fax:
Practice Address - Street 1:350 HILTON RD STE 201
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-6623
Practice Address - Country:US
Practice Address - Phone:843-497-3707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-04
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013232A122300000X
SC102991223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist