Provider Demographics
NPI:1912079708
Name:CRAWFORD, GARY WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:WAYNE
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 1:1930 BRAEBURN DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153
Mailing Address - Country:US
Mailing Address - Phone:540-774-1955
Mailing Address - Fax:540-989-2781
Practice Address - Street 1:1930 BRAEBURN DR
Practice Address - Street 2:SUITE A
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153
Practice Address - Country:US
Practice Address - Phone:540-774-1955
Practice Address - Fax:540-989-2781
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401004070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist