Provider Demographics
NPI:1134317464
Name:CRAWFORD ORTHODONTIC CARE
Entity Type:Organization
Organization Name:CRAWFORD ORTHODONTIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DMDDMV
Authorized Official - Phone:770-417-3505
Mailing Address - Street 1:3850 HOLCOMB BRIDGE RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-5223
Mailing Address - Country:US
Mailing Address - Phone:770-417-3505
Mailing Address - Fax:
Practice Address - Street 1:306 WEST STREET
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040
Practice Address - Country:US
Practice Address - Phone:770-417-3505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental