Provider Demographics
NPI:1316057706
Name:CROWLEY, GARY P (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:P
Last Name:CROWLEY
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 1:19 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-2503
Mailing Address - Country:US
Mailing Address - Phone:575-756-1236
Mailing Address - Fax:
Practice Address - Street 1:19 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-2503
Practice Address - Country:US
Practice Address - Phone:575-756-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO11505122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist