Provider Demographics
NPI:1174558944
Name:CROWELL, JEFFREY R (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:CROWELL
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 1:483 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-2817
Mailing Address - Country:US
Mailing Address - Phone:603-528-4444
Mailing Address - Fax:
Practice Address - Street 1:483 UNION AVE
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-2817
Practice Address - Country:US
Practice Address - Phone:603-528-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH18541223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30007336Medicaid