Provider Demographics
NPI:1942373220
Name:CRAWFORD, JONATHAN FROYD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:FROYD
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 1:515 GRAND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6061
Mailing Address - Country:US
Mailing Address - Phone:515-232-2090
Mailing Address - Fax:515-232-7660
Practice Address - Street 1:515 GRAND AVE STE 102
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6061
Practice Address - Country:US
Practice Address - Phone:515-232-2090
Practice Address - Fax:515-232-7660
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist