Provider Demographics
NPI:1235552407
Name:BRIAN C CRAWFORD AND PAOLO A POIDMORE, A DENTAL CORPORATION
Entity Type:Organization
Organization Name:BRIAN C CRAWFORD AND PAOLO A POIDMORE, A DENTAL CORPORATION
Other - Org Name:PRECISION ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:916-276-1220
Mailing Address - Street 1:4408 ELVERTA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-6723
Mailing Address - Country:US
Mailing Address - Phone:916-276-1220
Mailing Address - Fax:
Practice Address - Street 1:4408 ELVERTA RD STE 200
Practice Address - Street 2:
Practice Address - City:ANTELOPE
Practice Address - State:CA
Practice Address - Zip Code:95843-6723
Practice Address - Country:US
Practice Address - Phone:916-276-1220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA495041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty