Active NPI
Deontay Crawford
- Dentist
- Springfield, IL
National Provider Identifier
1306367388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.031207
- Practice address
- 2809 Mansion Rd Ste D
Springfield, IL 62711-6811 - Phone
- (217) 717-4405
- NPI assigned
- Jun 29, 2017
- Last updated
- Jun 29, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.031207 | IL | Primary |
Addresses
Primary practice location
2809 Mansion Rd Ste D
Springfield, IL 62711-6811
Mailing address
220 Sawgrass Dr Apt 7
Chatham, IL 62629-8118
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.031207 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498694400000",
"number": "1306367388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "220 SAWGRASS DR APT 7",
"city": "CHATHAM",
"state": "IL",
"postal_code": "626298118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2809 MANSION RD STE D",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627116811",
"telephone_number": "217-717-4405"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRAWFORD",
"first_name": "DEONTAY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-29",
"last_updated": "2017-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.031207",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.