Healthcare Provider Details

I. General information

NPI: 1720297344
Provider Name (Legal Business Name): ST.ELMO W. CRAWFORD D.D.S.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 BENNING RD NE
WASHINGTON DC
20002-4724
US

IV. Provider business mailing address

1922 BENNING RD NE
WASHINGTON DC
20002-4724
US

V. Phone/Fax

Practice location:
  • Phone: 202-399-2244
  • Fax: 202-388-1115
Mailing address:
  • Phone: 202-399-2244
  • Fax: 202-399-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN3272
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDEN3272
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDEN3272
License Number StateDC

VIII. Authorized Official

Name: DR. ST.ELMO WALLACE CRAWFORD JR.
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 202-399-2244