Provider Demographics
NPI:1255452231
Name:JOHN G CRAWFORD DDS LTD
Entity type:Organization
Organization Name:JOHN G CRAWFORD DDS LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:708-524-9788
Mailing Address - Street 1:505 N RIDGELAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2328
Mailing Address - Country:US
Mailing Address - Phone:708-524-9788
Mailing Address - Fax:708-524-0815
Practice Address - Street 1:505 N RIDGELAND AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2328
Practice Address - Country:US
Practice Address - Phone:708-524-9788
Practice Address - Fax:708-524-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty