Provider Demographics
NPI:1669643532
Name:CRAWFORD, BRUCE M (DMD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:M
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1703
Mailing Address - Country:US
Mailing Address - Phone:727-343-3005
Mailing Address - Fax:727-347-6429
Practice Address - Street 1:5601 1ST AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1703
Practice Address - Country:US
Practice Address - Phone:727-343-3005
Practice Address - Fax:727-347-6429
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00117921223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics