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General NPI Number Information
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NPI Number | 1366455297
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Entity Type | Organization
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Legal Business Name | DAN D. CRAIGE, D.D.S., INC.
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 203 N 16TH AVE
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City | DURANT
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State | OK
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Zip | 74701-3607
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Country | US
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Telephone | 580-924-2206
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Fax | 580-924-2215
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Provider Business Mailing Address
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Address Line | 203 N 16TH AVE
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City | DURANT
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State | OK
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Zip | 74701-3607
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Country | US
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Telephone | 580-924-2206
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Fax | 580-924-2215
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. DAN D. CRAIGE
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Credential | D.D.S.
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Telephone | 580-924-2206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4102
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License Number State | OK
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