Healthcare Provider Details

I. General information

NPI: 1386646412
Provider Name (Legal Business Name): JERRY CRAWFORD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 E ARAPAHOE RD SUITE 300
CENTENNIAL CO
80112-1279
US

IV. Provider business mailing address

7400 E ARAPAHOE RD SUITE 300
CENTENNIAL CO
80112-1279
US

V. Phone/Fax

Practice location:
  • Phone: 303-796-7400
  • Fax: 303-796-7956
Mailing address:
  • Phone: 303-796-7400
  • Fax: 303-796-7956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5144
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: