=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134379316
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA ASHLEY CRAIGHEAD D.M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2008
-----------------------------------------------------
Last Update Date | 09/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2660 S GREEN ST
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42420-4623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-831-9708
-----------------------------------------------------
Fax | 270-831-9749
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2611 HEARTLAND GREENS PT
-----------------------------------------------------
City | OWENSBORO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42303-1588
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-993-4377
-----------------------------------------------------
Fax | 270-831-9749
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 8445
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------