Healthcare Provider Details

I. General information

NPI: 1821136946
Provider Name (Legal Business Name): ANITRA MICHELLE CRAIG D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S PINE ST
VIVIAN LA
71082-3353
US

IV. Provider business mailing address

815 S PINE ST
VIVIAN LA
71082-3353
US

V. Phone/Fax

Practice location:
  • Phone: 318-375-3183
  • Fax: 318-731-3036
Mailing address:
  • Phone: 318-375-3183
  • Fax: 318-731-3036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8327
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6900
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6241
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: