MEDICARE: DR. GREGORY ALAN CRAWFORD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12006931A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194839373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY ALAN CRAWFORD DDS

Provider Business Mailing Address
First Line	:	4116 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-6911
Country	:	US
Telephone Number	:	260-482-3759
Fax Number	:	260-482-3750

Provider Business Practice Location Address
First Line	:	4116 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-6911
Country	:	US
Telephone Number	:	260-482-3759
Fax Number	:	260-482-3750

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	10/27/2011

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