Provider Demographics
NPI:1730719295
Name:CROSBY, CARRIE JO (RDH)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:JO
Last Name:CROSBY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 E MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-8964
Mailing Address - Country:US
Mailing Address - Phone:509-935-6001
Mailing Address - Fax:
Practice Address - Street 1:509 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-8964
Practice Address - Country:US
Practice Address - Phone:509-935-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH60675128124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist