Provider Demographics
NPI:1851311963
Name:CRAWFORD, PHILLIP C (DDS)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:C
Last Name:CRAWFORD
Suffix:
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 1:4824 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2108
Mailing Address - Country:US
Mailing Address - Phone:561-994-0047
Mailing Address - Fax:561-994-3931
Practice Address - Street 1:1200 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PAHOKEE
Practice Address - State:FL
Practice Address - Zip Code:33476-1102
Practice Address - Country:US
Practice Address - Phone:561-924-0184
Practice Address - Fax:561-924-2516
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN63241223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health