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General NPI Number Information
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NPI Number | 1568895613
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Entity Type | Organization
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Legal Business Name | CLINTON CRAWFORD DDS LLC
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 08/13/2013
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Provider Practice Location Address
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Address Line | 8913 WOODYARD RD B
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City | CLINTON
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State | MD
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Zip | 20735-4257
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Country | US
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Telephone | 301-363-2336
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Fax | 301-363-2317
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Provider Business Mailing Address
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Address Line | 8913 WOODYARD RD B
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City | CLINTON
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State | MD
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Zip | 20735-4257
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Country | US
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Telephone | 301-363-2336
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Fax | 301-363-2317
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KYIAH D GILL
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Credential | MPH
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Telephone | 240-839-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 14056
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License Number State | MD
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