Individual
DERRICK MYRON CRAWFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
505 S MOUNTAIN VIEW RD, MOSCOW, ID 83843-9205
(208) 882-6360
Mailing address
1005 SW LATOUR PEAK ST, PULLMAN, WA 99163-5287
(626) 260-0729
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D-5265
ID
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
DE61157527
WA
Other
Enumeration date
06/11/2021
Last updated
06/11/2021
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