Provider Demographics
NPI:1659384279
Name:CRAWLEY, THERESA YOUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:YOUNG
Last Name:CRAWLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 FALL HILL AVENUE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3571
Mailing Address - Country:US
Mailing Address - Phone:540-371-1090
Mailing Address - Fax:540-371-5230
Practice Address - Street 1:1701 FALL HILL AVENUE
Practice Address - Street 2:SUITE 106
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3571
Practice Address - Country:US
Practice Address - Phone:540-371-1090
Practice Address - Fax:540-371-5230
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006162122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist