Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 26005 | FL |
NPI | 1003488594 |
---|---|
Provider Name | Dr. Benjamin Scott Crawford |
First Address | Freeport, FL 32439-2382 |
Second Address | Santa Rosa Beach, FL 32459-3245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2021 |
Last Update Date | 14/07/2021 |