Individual
SHERI CRAWFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1405 MEDICAL PARK DR, FORT WAYNE, IN 46825-5889
(404) 578-1018
Mailing address
1405 MEDICAL PARK DR, FORT WAYNE, IN 46825-5889
(404) 578-1018
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
9583
KY
1223G0001X
General Practice Dentistry
Primary
12013723A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12013723A
IN DENTAL LICENSE
IN
01
—
1811604440
NPI TYPE 2
IN
Enumeration date
08/25/2016
Last updated
11/02/2022
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