MEDICARE: CRAYCROFT PRIME DENTAL, P.C.

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	122300000X	Dentist

General Provider Information

NPI Number	:	1700439544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAYCROFT PRIME DENTAL, P.C.

Provider Business Mailing Address
First Line	:	12930 N TOPANGA DR
Second Line	:
City	:	ORO VALLEY
State	:	AZ
Zip	:	85755-8725
Country	:	US
Telephone Number	:	716-225-9244
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 N CRAYCROFT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-3702
Country	:	US
Telephone Number	:	520-886-2822
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. SARAH KYM
Credential	:	D.D.S
Telephone Number	:	716-225-9244

Provider Enumeration Date	:	07/22/2019
Last Update Date	:	07/22/2019

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