Individual
SUPRENA L CRAWFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
112 W 6TH ST, EAGLE, CO 81631
(970) 819-0370
Mailing address
PO BOX 1962, EAGLE, CO 81631-1962
(970) 819-0370
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
904264
CO
Other
Enumeration date
05/05/2014
Last updated
08/13/2021
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