Provider Demographics
NPI:1457403974
Name:VICTOR X CRAWFORD DDS INC
Entity Type:Organization
Organization Name:VICTOR X CRAWFORD DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:XAVIER
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-264-0179
Mailing Address - Street 1:5106 FEDERAL BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-5455
Mailing Address - Country:US
Mailing Address - Phone:619-264-0179
Mailing Address - Fax:619-264-4364
Practice Address - Street 1:5106 FEDERAL BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-5455
Practice Address - Country:US
Practice Address - Phone:619-264-0179
Practice Address - Fax:619-264-4364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26161122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB2616101Medicaid