Provider Demographics
NPI:1588875850
Name:CROWE, ROY ERVIN JR (DDSPC)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:ERVIN
Last Name:CROWE
Suffix:JR
Gender:M
Credentials:DDSPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5364
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30154-0007
Mailing Address - Country:US
Mailing Address - Phone:770-855-9594
Mailing Address - Fax:
Practice Address - Street 1:6128 PRESTLEY MILL ROAD
Practice Address - Street 2:SUITE E
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134
Practice Address - Country:US
Practice Address - Phone:770-949-8822
Practice Address - Fax:770-949-5407
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN009030122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist