Basic Information
Provider Information
NPI: 1033556568
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CROWLEY
FirstName: PATRICK
MiddleName: JOHN
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10121 SE 55TH ST
Address2:  
City: OKLAHOMA CITY
State: OK
PostalCode: 731504533
CountryCode: US
TelephoneNumber: 4052263700
FaxNumber:  
Practice Location
Address1: 7130 W HEFNER RD
Address2:  
City: OKLAHOMA CITY
State: OK
PostalCode: 731624502
CountryCode: US
TelephoneNumber: 4057220123
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/23/2013
LastUpdateDate: 05/23/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X6478OKY Dental ProvidersDentistGeneral Practice

No ID Information.


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