Provider Demographics
NPI:1548512254
Name:CRAWFORD, VICTOR XAVIER (DDS)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:XAVIER
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5106 FEDERAL BLVD.
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-5455
Mailing Address - Country:US
Mailing Address - Phone:619-264-0179
Mailing Address - Fax:619-264-6824
Practice Address - Street 1:5106 FEDERAL BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-5453
Practice Address - Country:US
Practice Address - Phone:619-264-0179
Practice Address - Fax:619-264-6824
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26161122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD26161Medicaid