Micah Crowley, D.M.D.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DDS107031 Issued in CA

Practice address

505 1/2 Carnation Ave
Corona del Mar, CA 92625-2046

Phone

(406) 459-6140

NPI assigned

Jun 24, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1403568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635206400000",
    "number": "1386059772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 1/2 CARNATION AVE",
            "city": "CORONA DEL MAR",
            "state": "CA",
            "postal_code": "926252046",
            "telephone_number": "406-459-6140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 1/2 CARNATION AVE",
            "city": "CORONA DEL MAR",
            "state": "CA",
            "postal_code": "926252046",
            "telephone_number": "406-459-6140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROWLEY",
        "first_name": "MICAH",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-24",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS039876",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "DDS107031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna Felker Cody, M.S.
• Maxine Beth Cohen, MFT
• Kathleen Ann Colao, LMFT, RDN
• Andrea Marie Colon, ND
• Eulalia Cortez
• Ellen Dale, PT, DPT
• Nori Deatherage
• Deva Health, Corp.
• Elisa Dombrowski, MFT
• Arlene Dorius, PH.D.

• Periodontics in Corona del Mar, CA
• Providers in Corona del Mar, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.