Provider Demographics
NPI:1053726919
Name:KNOX-CROUANAS, AUDRIE (DDS)
Entity type:Individual
Prefix:
First Name:AUDRIE
Middle Name:
Last Name:KNOX-CROUANAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6238
Mailing Address - Country:US
Mailing Address - Phone:207-784-5769
Mailing Address - Fax:
Practice Address - Street 1:480 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6238
Practice Address - Country:US
Practice Address - Phone:207-784-5769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4380122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist