Provider Demographics
NPI:1003488594
Name:CRAWFORD, BENJAMIN SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:SCOTT
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 LIGHTNING BUG LN
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32439-2382
Mailing Address - Country:US
Mailing Address - Phone:248-331-7175
Mailing Address - Fax:
Practice Address - Street 1:2010 W 98 US-SUITE102
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-3245
Practice Address - Country:US
Practice Address - Phone:850-601-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26005122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist