Provider Demographics
NPI:1659801470
Name:PAOLO A. POIDMORE AND BRIAN C. CRAWFORD, A DENTAL CORPORATION
Entity Type:Organization
Organization Name:PAOLO A. POIDMORE AND BRIAN C. CRAWFORD, A DENTAL CORPORATION
Other - Org Name:CALI KIDS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-823-1100
Mailing Address - Street 1:11961 HERITAGE OAK PL
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2461
Mailing Address - Country:US
Mailing Address - Phone:530-823-1100
Mailing Address - Fax:530-823-3019
Practice Address - Street 1:11961 HERITAGE OAK PL
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2461
Practice Address - Country:US
Practice Address - Phone:530-823-1100
Practice Address - Fax:530-823-3019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty