Provider Demographics
NPI:1851498711
Name:CRAWFORD, ROBERT MARVIN
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARVIN
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:22629 TWAIN HARTE DR
Mailing Address - Street 2:
Mailing Address - City:TWAIN HARTE
Mailing Address - State:CA
Mailing Address - Zip Code:95383-9628
Mailing Address - Country:US
Mailing Address - Phone:209-586-2772
Mailing Address - Fax:
Practice Address - Street 1:22629 TWAIN HARTE DR
Practice Address - Street 2:
Practice Address - City:TWAIN HARTE
Practice Address - State:CA
Practice Address - Zip Code:95383-9628
Practice Address - Country:US
Practice Address - Phone:209-586-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 255001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics