Provider Demographics
NPI:1386771632
Name:CRAWFORD, CRAIG HANNIE (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:HANNIE
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 1:701 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-1523
Mailing Address - Country:US
Mailing Address - Phone:337-478-7590
Mailing Address - Fax:337-478-1804
Practice Address - Street 1:701 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-1523
Practice Address - Country:US
Practice Address - Phone:337-478-7590
Practice Address - Fax:337-478-1804
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA49481223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics