Healthcare Provider Details

I. General information

NPI: 1801093844
Provider Name (Legal Business Name): FRANK CONYNGHAM CRAWFORD II D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74-900 HWY 111 SUITE 210
INDIAN WELLS CA
92210
US

IV. Provider business mailing address

74-900 HWY 111 SUITE 210
INDIAN WELLS CA
92210
US

V. Phone/Fax

Practice location:
  • Phone: 760-346-5678
  • Fax: 760-340-5680
Mailing address:
  • Phone: 760-346-5678
  • Fax: 760-340-5680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number15029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: