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General NPI Number Information
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NPI Number | 1861610081
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Entity Type | Organization
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Legal Business Name | CRAWFORD ORTHODONTIC CARE, P.C.
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3850 HOLCOMB BRIDGE RD SUITE 230
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City | NORCROSS
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State | GA
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Zip | 30092-5223
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Country | US
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Telephone | 770-447-5311
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Fax | 770-447-1865
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Provider Business Mailing Address
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Address Line | 3850 HOLCOMB BRIDGE RD SUITE 230
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City | NORCROSS
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State | GA
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Zip | 30092-5223
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Country | US
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Telephone | 770-447-5311
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Fax | 770-447-1865
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Authorized Official
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Title or Position | OWNER
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Name | MR. KEITH SCOTT CRAWFORD
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Credential |
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Telephone | 770-447-5311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN009310
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License Number State | GA
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