Healthcare Provider Details

I. General information

NPI: 1568382497
Provider Name (Legal Business Name): DONOVAN CRAWFORD DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GROVE ST STE 303
HERNDON VA
20170-4793
US

IV. Provider business mailing address

8231 CRESTWOOD HEIGHTS DR APT 611
MC LEAN VA
22102-2246
US

V. Phone/Fax

Practice location:
  • Phone: 703-793-1771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401420025
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: