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General NPI Number Information
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NPI Number | 1871315259
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Entity Type | Organization
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Legal Business Name | PAOLO A POIDMORE AND BRIAN C CRAWFORD DENTAL CORPORATION
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 4408 ELVERTA RD STE 200
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City | ANTELOPE
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State | CA
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Zip | 95843-6723
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Country | US
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Telephone | 916-259-9255
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Fax | 916-384-3844
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Provider Business Mailing Address
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Address Line | 3075 BEACON BLVD
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City | WEST SACRAMENTO
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State | CA
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Zip | 95691-3462
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Country | US
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Telephone | 916-259-9255
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Fax | 916-384-3844
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN CRAWFORD
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Credential | DDS
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Telephone | 916-259-9255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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