Provider Demographics
NPI:1386618072
Name:CAROLYN B CROWELL DMD INC
Entity type:Organization
Organization Name:CAROLYN B CROWELL DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:BURKE
Authorized Official - Last Name:CROWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:440-899-9600
Mailing Address - Street 1:36855 AMERICAN WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011
Mailing Address - Country:US
Mailing Address - Phone:440-934-0149
Mailing Address - Fax:
Practice Address - Street 1:36855 AMERICAN WAY STE C
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-4059
Practice Address - Country:US
Practice Address - Phone:440-934-0149
Practice Address - Fax:440-934-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH190251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0748856Medicaid