Provider Demographics
NPI:1669879946
Name:CRAWFORD, JAMES JOHN (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOHN
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N WATER ST UNIT 201
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-5732
Mailing Address - Country:US
Mailing Address - Phone:262-515-3003
Mailing Address - Fax:414-364-2414
Practice Address - Street 1:205 N WATER ST UNIT 201
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-5732
Practice Address - Country:US
Practice Address - Phone:262-455-0016
Practice Address - Fax:414-364-2414
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039762122300000X
WI1001285-151223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDental AnesthesiologyGroup - Single Specialty
No122300000XDental ProvidersDentist