Healthcare Provider Details

I. General information

NPI: 1811976608
Provider Name (Legal Business Name): TERRYL MIGUEL CRAWFORD DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 W MARTIN LUTHER KING BLVD
TAMPA FL
33603-3337
US

IV. Provider business mailing address

825 W MARTIN LUTHER KING BLVD
TAMPA FL
33603-3337
US

V. Phone/Fax

Practice location:
  • Phone: 813-237-1982
  • Fax: 813-232-0744
Mailing address:
  • Phone: 813-237-1982
  • Fax: 813-232-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN16500
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: