Healthcare Provider Details

I. General information

NPI: 1427176916
Provider Name (Legal Business Name): B. CASEY CRAFTON D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10380 OLD COLUMBIA RD STE 102
COLUMBIA MD
21046-2005
US

IV. Provider business mailing address

4231 LELAND ST
CHEVY CHASE MD
20815-6048
US

V. Phone/Fax

Practice location:
  • Phone: 410-381-0900
  • Fax: 410-381-7960
Mailing address:
  • Phone: 301-657-7829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number09863
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: