Provider Demographics
NPI:1114014917
Name:CRAWFORD, PATRICK J (DDS, SC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:DDS, SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7851 COOPER ROAD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-4181
Mailing Address - Country:US
Mailing Address - Phone:262-694-5191
Mailing Address - Fax:
Practice Address - Street 1:7851 COOPER ROAD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-4181
Practice Address - Country:US
Practice Address - Phone:262-694-5191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice