Provider Demographics
NPI:1972949535
Name:TOUSSAINT CRAWFORD DDS LLC
Entity Type:Organization
Organization Name:TOUSSAINT CRAWFORD DDS LLC
Other - Org Name:FENTON FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KYIAH
Authorized Official - Middle Name:DANELLE
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:240-839-5100
Mailing Address - Street 1:8630 FENTON ST
Mailing Address - Street 2:708
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3806
Mailing Address - Country:US
Mailing Address - Phone:240-839-5100
Mailing Address - Fax:240-839-5101
Practice Address - Street 1:8630 FENTON ST
Practice Address - Street 2:708
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3806
Practice Address - Country:US
Practice Address - Phone:240-839-5100
Practice Address - Fax:240-839-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14056122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty