Provider Demographics
NPI:1477671840
Name:CRAWFORD, GLENDA P (DMD)
Entity Type:Individual
Prefix:DR
First Name:GLENDA
Middle Name:P
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:W
Other - Last Name:CRAWFORD
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1131 RUTHERFORD RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-3905
Mailing Address - Country:US
Mailing Address - Phone:864-271-9062
Mailing Address - Fax:864-271-9067
Practice Address - Street 1:1131 RUTHERFORD RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-3905
Practice Address - Country:US
Practice Address - Phone:864-271-9062
Practice Address - Fax:864-271-9067
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38221223G0001X
SC37081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice