Provider Demographics
NPI:1619373693
Name:CRAWFORD, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 E HIGHWAY 114
Mailing Address - Street 2:SUITE 170
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-6684
Mailing Address - Country:US
Mailing Address - Phone:817-490-9885
Mailing Address - Fax:817-491-2313
Practice Address - Street 1:2001 E HIGHWAY 114
Practice Address - Street 2:SUITE 170
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-6684
Practice Address - Country:US
Practice Address - Phone:817-490-9885
Practice Address - Fax:817-491-2313
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX181711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice