Provider Demographics
NPI:1770568453
Name:CRIGGER, LAURENCE PAUL (DDS)
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:PAUL
Last Name:CRIGGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 DENTAL SQUADRON SGD
Mailing Address - Street 2:149 HART STREET STE 4
Mailing Address - City:SHEPPARD AFB
Mailing Address - State:TX
Mailing Address - Zip Code:76311
Mailing Address - Country:US
Mailing Address - Phone:940-676-4474
Mailing Address - Fax:940-676-5903
Practice Address - Street 1:82 DENTAL SQUADRON SGD
Practice Address - Street 2:149 HART STREET STE 4
Practice Address - City:SHEPPARD AFB
Practice Address - State:TX
Practice Address - Zip Code:76311
Practice Address - Country:US
Practice Address - Phone:940-676-4474
Practice Address - Fax:940-676-5903
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice