Provider Demographics
NPI:1922391390
Name:LARRY B. CRAWFORD, D.D.S., M.S.D., INC.
Entity type:Organization
Organization Name:LARRY B. CRAWFORD, D.D.S., M.S.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:951-789-1888
Mailing Address - Street 1:301 E ALESSANDRO BLVD STE 3B
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-2464
Mailing Address - Country:US
Mailing Address - Phone:951-789-1888
Mailing Address - Fax:951-789-8878
Practice Address - Street 1:301 E ALESSANDRO BLVD STE 3B
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-2464
Practice Address - Country:US
Practice Address - Phone:951-789-1888
Practice Address - Fax:951-789-8878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA326391223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty