Provider Demographics
NPI:1659548477
Name:CRAWFORD, MICHAEL DANIEL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DANIEL
Last Name:CRAWFORD
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 MAIN ST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2093
Mailing Address - Country:US
Mailing Address - Phone:860-423-1357
Mailing Address - Fax:860-423-3343
Practice Address - Street 1:1185 MAIN ST
Practice Address - Street 2:SUITE #3
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2093
Practice Address - Country:US
Practice Address - Phone:860-423-1357
Practice Address - Fax:860-423-3343
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0102401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice