Provider Demographics
NPI:1528117967
Name:CRAWFORD, SHANA XAVIERA (DDS)
Entity type:Individual
Prefix:DR
First Name:SHANA
Middle Name:XAVIERA
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:XAVIERA
Other - Last Name:CRAWFORD-HAWKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:101 DALLAS TOWNE PLZ
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-1564
Mailing Address - Country:US
Mailing Address - Phone:704-675-8667
Mailing Address - Fax:704-675-8669
Practice Address - Street 1:101 DALLAS TOWNE PLZ
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034-1564
Practice Address - Country:US
Practice Address - Phone:704-675-8667
Practice Address - Fax:704-675-8669
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5921514Medicaid