MEDICARE: DR. CRAIG MITCHELL INGLIS DMD

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	DN008878	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	DN008878	OTHER	GA	DENTIST LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396747705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG MITCHELL INGLIS DMD

Provider Business Mailing Address
First Line	:	283 WOODBRIER
Second Line	:
City	:	SAUTEE NACOOCHEE
State	:	GA
Zip	:	30571-2056
Country	:	US
Telephone Number	:	706-878-1934
Fax Number	:

Provider Business Practice Location Address
First Line	:	1290 ATHENS ST
Second Line	:	HALL COUNTY HEALTH DEPARTMENT
City	:	GAINESVILLE
State	:	GA
Zip	:	30507-7000
Country	:	US
Telephone Number	:	770-531-5609
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	11/22/2010

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