Healthcare Provider Details

I. General information

NPI: 1932309077
Provider Name (Legal Business Name): JOHN BURNS CRAWFORD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 CERNON ST SUITE B
VACAVILLE CA
95688-4549
US

IV. Provider business mailing address

412 CERNON ST SUITE B
VACAVILLE CA
95688-4549
US

V. Phone/Fax

Practice location:
  • Phone: 707-447-0900
  • Fax: 707-447-0956
Mailing address:
  • Phone: 707-447-0900
  • Fax: 707-447-0956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number25791
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: