Provider Demographics
NPI:1487705208
Name:JODY L. CROWL, D.D.S.
Entity type:Organization
Organization Name:JODY L. CROWL, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CROWL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-628-8741
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-0338
Mailing Address - Country:US
Mailing Address - Phone:406-628-8741
Mailing Address - Fax:406-628-8741
Practice Address - Street 1:113 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MT
Practice Address - Zip Code:59044-3106
Practice Address - Country:US
Practice Address - Phone:406-628-8741
Practice Address - Fax:406-628-8741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0111670Medicaid
MT5510839OtherBLUE CHIP