Provider Demographics
NPI:1174193809
Name:CRAWFORD, CAROLINE LEE (DDS)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:LEE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:LEE
Other - Last Name:LITTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:214 COUNTY ROAD 714
Mailing Address - Street 2:
Mailing Address - City:GASSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72635-7910
Mailing Address - Country:US
Mailing Address - Phone:870-421-4230
Mailing Address - Fax:
Practice Address - Street 1:301 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3944
Practice Address - Country:US
Practice Address - Phone:870-424-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR45221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice