Provider Demographics
NPI:1194988139
Name:CROWN, JOHN WARD (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WARD
Last Name:CROWN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-1472
Mailing Address - Country:US
Mailing Address - Phone:815-895-4571
Mailing Address - Fax:815-895-2356
Practice Address - Street 1:134 W STATE ST
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-1472
Practice Address - Country:US
Practice Address - Phone:815-895-4571
Practice Address - Fax:815-895-2356
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19023694122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist