Provider Demographics
NPI:1003934746
Name:CRAWFORD, ELWYN LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELWYN
Middle Name:LEE
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 PINE MILL RD
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-3448
Mailing Address - Country:US
Mailing Address - Phone:903-785-0276
Mailing Address - Fax:903-785-8822
Practice Address - Street 1:2920 PINE MILL RD
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-3448
Practice Address - Country:US
Practice Address - Phone:903-785-0276
Practice Address - Fax:903-785-8821
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX167661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice