Provider Demographics
NPI:1235552407
Name:BRIAN C CRAWFORD AND PAOLO A POIDMORE, A DENTAL CORPORATION
Entity type:Organization
Organization Name:BRIAN C CRAWFORD AND PAOLO A POIDMORE, A DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:916-276-1220
Mailing Address - Street 1:3075 BEACON BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3462
Mailing Address - Country:US
Mailing Address - Phone:916-259-9255
Mailing Address - Fax:
Practice Address - Street 1:4408 ELVERTA RD STE 200
Practice Address - Street 2:
Practice Address - City:ANTELOPE
Practice Address - State:CA
Practice Address - Zip Code:95843-6723
Practice Address - Country:US
Practice Address - Phone:916-276-1220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty