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General NPI Number Information
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NPI Number | 1295011880
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Entity Type | Organization
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Legal Business Name | J. ANDREW CRAYCROFT D.M.D. INC.
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 1711 ASHLEY CIR SUITE 3
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City | BOWLING GREEN
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State | KY
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Zip | 42104-5801
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Country | US
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Telephone | 270-781-4997
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Fax | 270-781-8557
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Provider Business Mailing Address
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Address Line | 1711 ASHLEY CIR SUITE 3
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City | BOWLING GREEN
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State | KY
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Zip | 42104-5801
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Country | US
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Telephone | 270-781-4997
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Fax | 270-781-8557
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Authorized Official
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Title or Position | OFFICE MGR.
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Name | JANET M. LONGEST
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Credential |
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Telephone | 270-781-4997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6137
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License Number State | KY
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