Provider Demographics
NPI:1720112709
Name:CRAWFORD, ALLEN JR (DMD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:CRAWFORD
Suffix:JR
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 1:530 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-1213
Mailing Address - Country:US
Mailing Address - Phone:610-966-5124
Mailing Address - Fax:
Practice Address - Street 1:530 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-1724
Practice Address - Country:US
Practice Address - Phone:610-966-5124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0177891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice