Provider Demographics
NPI:1871315259
Name:PAOLO A POIDMORE AND BRIAN C CRAWFORD DENTAL CORPORATION
Entity type:Organization
Organization Name:PAOLO A POIDMORE AND BRIAN C CRAWFORD DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-259-9255
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:916-384-3844
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:916-259-9255
Practice Address - Fax:916-384-3844
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAOLO A POIDMORE AND BRIAN C CRAWFORD DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-28
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty