Provider Demographics
NPI:1760554125
Name:ERIC CRAWFORD DDS
Entity type:Organization
Organization Name:ERIC CRAWFORD DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-353-1502
Mailing Address - Street 1:6017 W 45TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-5100
Mailing Address - Country:US
Mailing Address - Phone:806-353-1502
Mailing Address - Fax:806-331-0980
Practice Address - Street 1:6017 W 45TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5100
Practice Address - Country:US
Practice Address - Phone:806-353-1502
Practice Address - Fax:806-331-0980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty