Provider Demographics
NPI:1891858403
Name:MICHAEL D CRAWFORD DDS INC
Entity Type:Organization
Organization Name:MICHAEL D CRAWFORD DDS INC
Other - Org Name:MURPHY CANYON DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-268-8112
Mailing Address - Street 1:5250 MURPHY CANYON ROAD
Mailing Address - Street 2:#122
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:858-268-8112
Mailing Address - Fax:858-268-4218
Practice Address - Street 1:5250 MURPHY CANYON ROAD
Practice Address - Street 2:#122
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-268-8112
Practice Address - Fax:858-268-4218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23815122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9224702Medicaid
CAB2381502OtherDELTA DENTAL HEALTHY FAMI