Provider Demographics
NPI:1083612170
Name:CHARLES H. CRAWFORD, JR DMD
Entity Type:Organization
Organization Name:CHARLES H. CRAWFORD, JR DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HARMON
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-324-7540
Mailing Address - Street 1:1236 EBENEZER RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2300
Mailing Address - Country:US
Mailing Address - Phone:803-324-7540
Mailing Address - Fax:803-324-4128
Practice Address - Street 1:1236 EBENEZER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2300
Practice Address - Country:US
Practice Address - Phone:803-324-7540
Practice Address - Fax:803-324-4128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA-9869Medicaid