Provider Demographics
NPI:1073755435
Name:PEDIATRIC DENTAL PARTNERS, LLP
Entity Type:Organization
Organization Name:PEDIATRIC DENTAL PARTNERS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-865-2250
Mailing Address - Street 1:318 CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4132
Mailing Address - Country:US
Mailing Address - Phone:318-865-2250
Mailing Address - Fax:318-865-3751
Practice Address - Street 1:318 CARROLL ST.
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4132
Practice Address - Country:US
Practice Address - Phone:318-865-2250
Practice Address - Fax:318-865-3751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA31331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty