Provider Demographics
NPI:1386317899
Name:CRAWFORD, GARRETT B (DMD)
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:B
Last Name:CRAWFORD
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 1:1661 WASHINGTON ST APT 201
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3389
Mailing Address - Country:US
Mailing Address - Phone:727-542-4275
Mailing Address - Fax:
Practice Address - Street 1:184 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-2911
Practice Address - Country:US
Practice Address - Phone:781-739-3933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL263561223G0001X
MADN1859196122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice