Healthcare Provider Details

I. General information

NPI: 1083612170
Provider Name (Legal Business Name): CHARLES H. CRAWFORD, JR DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 EBENEZER RD SUITE 110
ROCK HILL SC
29732-2300
US

IV. Provider business mailing address

1236 EBENEZER RD SUITE 110
ROCK HILL SC
29732-2300
US

V. Phone/Fax

Practice location:
  • Phone: 803-324-7540
  • Fax: 803-324-4128
Mailing address:
  • Phone: 803-324-7540
  • Fax: 803-324-4128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateSC

VIII. Authorized Official

Name: DR. CHARLES HARMON CRAWFORD JR.
Title or Position: PRESIDENT
Credential: DMD
Phone: 803-324-7540