Provider Demographics
NPI:1134352610
Name:CRAWFORD, LAUREN E (DMD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:E
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 BUSINESS CENTER DR STE 1
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4401
Mailing Address - Country:US
Mailing Address - Phone:904-215-3323
Mailing Address - Fax:
Practice Address - Street 1:1515 BUSINESS CENTER DR STE 1
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4401
Practice Address - Country:US
Practice Address - Phone:904-215-3323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60309056122300000X
FLDN21524122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist