Suprena L Crawford, RDH
Individual provider Active NPI Dental Hygienist · Eagle, CO
NPI 1649680232 · NPPES record last updated Aug 13, 2021
Key facts
- NPI
- 1649680232
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Hygienist 124Q00000X
- License
- 904264 (CO)
- Practice address
- 112 W 6TH St
Eagle, CO 81631 - Phone
- (970) 819-0370
- NPI assigned
- May 5, 2014
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 904264 | CO | MD | Dental Hygienist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 904264 | CO | Yes |
Addresses
Primary practice location
112 W 6TH St
Eagle, CO 81631
Mailing address
PO Box 1962
Eagle, CO 81631-1962
Phone (970) 819-0370
Other providers in Eagle, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.