Provider Demographics
NPI:1194761213
Name:CROSBY, MARY CECILIA (DDS)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CECILIA
Last Name:CROSBY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:M
Other - Middle Name:CECILIA
Other - Last Name:CROSBY-EL-AMIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS PA
Mailing Address - Street 1:4300 SW 92 AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328
Mailing Address - Country:US
Mailing Address - Phone:954-424-1965
Mailing Address - Fax:
Practice Address - Street 1:5607 NW 27TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-2826
Practice Address - Country:US
Practice Address - Phone:305-376-6400
Practice Address - Fax:305-636-5155
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00112361223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113244600Medicaid