Provider Demographics
NPI:1518721760
Name:CRAWFORD IMPLANT & LASER PERIODONTICS PLLC
Entity Type:Organization
Organization Name:CRAWFORD IMPLANT & LASER PERIODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:MADALINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-542-3096
Mailing Address - Street 1:5601 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1703
Mailing Address - Country:US
Mailing Address - Phone:727-343-3005
Mailing Address - Fax:
Practice Address - Street 1:5601 1ST AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1703
Practice Address - Country:US
Practice Address - Phone:727-343-3005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1386317899OtherDMD
FL1669643532OtherDMD