Provider Demographics
NPI:1952422248
Name:CRAWFORD, JOHN GEORGE III (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GEORGE
Last Name:CRAWFORD
Suffix:III
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:37352 S MACKS RD
Mailing Address - Street 2:
Mailing Address - City:CUSTER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60481-8426
Mailing Address - Country:US
Mailing Address - Phone:708-790-9788
Mailing Address - Fax:708-524-0815
Practice Address - Street 1:401 WALL ST UNIT D
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2585
Practice Address - Country:US
Practice Address - Phone:219-286-6228
Practice Address - Fax:219-217-3673
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0008321223P0221X
IL021.0009391223X0400X
IN12013818A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL021.000832OtherSPECIALIST, PEDODONTICS
IL019.000939OtherDENTAL LICENSE
IL021.000939OtherSPECIALIST, ORTHODONTICS
IN12013818AOtherDENTAL LICENSE