Provider Demographics
NPI:1194888933
Name:CRAWSHAW, KYLE (DMD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:CRAWSHAW
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2458 SE BURNSIDE RD
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-1247
Mailing Address - Country:US
Mailing Address - Phone:503-666-8045
Mailing Address - Fax:503-666-8045
Practice Address - Street 1:34055 SOLON RD
Practice Address - Street 2:SUITE 111
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2662
Practice Address - Country:US
Practice Address - Phone:440-349-1400
Practice Address - Fax:440-349-0558
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9846122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist