Provider Demographics
NPI:1740492081
Name:CRAWFORD, LARRY B
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:B
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E ALESSANDRO BLVD STE 3B
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-2464
Mailing Address - Country:US
Mailing Address - Phone:951-789-1888
Mailing Address - Fax:951-789-8878
Practice Address - Street 1:301 E ALESSANDRO BLVD STE 3B
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-2464
Practice Address - Country:US
Practice Address - Phone:951-789-1888
Practice Address - Fax:951-789-8878
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA326391223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics