MEDICARE: LINDA CRAWFORD DMD PC INC

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	332BC3200X	Customized Equipment (DME)
2	261QD0000X	Dental Clinic/Center	4011	AL

General Provider Information

NPI Number	:	1912484676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINDA CRAWFORD DMD PC INC

Provider Business Mailing Address
First Line	:	4985 SPARKMAN DR NW
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35810-3950
Country	:	US
Telephone Number	:	256-534-3337
Fax Number	:	256-534-3337

Provider Business Practice Location Address
First Line	:	4985 SPARKMAN DR NW
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35810-3950
Country	:	US
Telephone Number	:	256-534-3337
Fax Number	:	256-534-3337

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LINDA CRAWFORD
Credential	:	DMD
Telephone Number	:	256-534-3337

Provider Enumeration Date	:	07/25/2018
Last Update Date	:	07/25/2018

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