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General NPI Number Information
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NPI Number | 1487766432
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Entity Type | Organization
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Legal Business Name | MARTIN CRANE, A DENTAL CORPORATION
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6600 MADISON AVE STE 4A
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City | CARMICHAEL
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State | CA
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Zip | 95608-0645
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Country | US
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Telephone | 916-961-2475
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Fax | 916-961-7968
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Provider Business Mailing Address
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Address Line | 6600 MADISON AVE STE 4A
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City | CARMICHAEL
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State | CA
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Zip | 95608-0645
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Country | US
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Telephone | 916-961-2475
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Fax | 916-961-7968
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARTIN ALLEN CRANE
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Credential | D.D.S
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Telephone | 916-961-2475
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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 | 23721
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License Number State | CA
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