Individual
DR. GREGORY ALAN CRAWFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4116 E STATE BLVD, FORT WAYNE, IN 46815-6911
(260) 482-3759
(260) 482-3750
Mailing address
4116 E STATE BLVD, FORT WAYNE, IN 46815-6911
(260) 482-3759
(260) 482-3750
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12006931A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100050850A
—
IN
Enumeration date
08/18/2006
Last updated
10/27/2011
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