Provider Demographics
NPI:1508267675
Name:CRAWFORD, LEE
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6017 SW 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-5100
Mailing Address - Country:US
Mailing Address - Phone:806-353-1502
Mailing Address - Fax:806-331-0980
Practice Address - Street 1:6017 SW 45TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5100
Practice Address - Country:US
Practice Address - Phone:806-353-1502
Practice Address - Fax:806-331-0980
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice