MEDICARE: CRANFORD FAMILY DENTISTRY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1114854205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRANFORD FAMILY DENTISTRY, LLC

Provider Business Mailing Address
First Line	:	3626 CYPRESS ST
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-7314
Country	:	US
Telephone Number	:	318-396-9667
Fax Number	:	318-396-9616

Provider Business Practice Location Address
First Line	:	3626 CYPRESS ST
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-7314
Country	:	US
Telephone Number	:	318-396-9667
Fax Number	:	318-396-9616

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. RUSSELL WAYNE CRANFORD
Credential	:	DDS
Telephone Number	:	318-396-9667

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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