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General NPI Number Information
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NPI Number | 1922391390
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Entity Type | Organization
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Legal Business Name | LARRY B. CRAWFORD, D.D.S., M.S.D., INC.
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Dates
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Enumeration Date | 05/18/2011
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Last Update Date | 05/18/2011
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Provider Practice Location Address
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Address Line | 301 E ALESSANDRO BLVD STE 3B
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City | RIVERSIDE
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State | CA
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Zip | 92508-2464
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Country | US
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Telephone | 951-789-1888
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Fax | 951-789-8878
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Provider Business Mailing Address
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Address Line | 301 E ALESSANDRO BLVD STE 3B
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City | RIVERSIDE
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State | CA
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Zip | 92508-2464
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Country | US
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Telephone | 951-789-1888
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Fax | 951-789-8878
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LARRY B. CRAWFORD
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Credential | D.D.S., M.S.D.
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Telephone | 951-789-1888
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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 | 32639
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License Number State | CA
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