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General NPI Number Information
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NPI Number | 1700290491
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Entity Type | Organization
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Legal Business Name | CRAWFORD DENTAL
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Dates
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Enumeration Date | 06/20/2014
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Last Update Date | 06/20/2014
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Provider Practice Location Address
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Address Line | 1115 S MAIN ST
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City | FORT SCOTT
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State | KS
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Zip | 66701-2651
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Country | US
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Telephone | 620-223-4448
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Fax | 620-223-9957
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Provider Business Mailing Address
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Address Line | 1115 S MAIN ST
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City | FORT SCOTT
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State | KS
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Zip | 66701-2651
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Country | US
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Telephone | 620-223-4448
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Fax | 620-223-9957
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | MR. TIMOTHY P. CRAWFORD
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Credential | D.M.D
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Telephone | 620-223-4448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 60757
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License Number State | KS
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