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General NPI Number Information
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NPI Number | 1497233704
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Entity Type | Organization
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Legal Business Name | CRANFILL DENTAL WV PLLC
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 209 WASHINGTON ST W
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City | CHARLESTON
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State | WV
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Zip | 25302-2348
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Country | US
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Telephone | 502-244-2441
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Fax | 502-254-4069
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Provider Business Mailing Address
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Address Line | 12910 SHELBYVILLE RD STE 300
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City | LOUISVILLE
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State | KY
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Zip | 40243-2404
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Country | US
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Telephone | 502-244-2441
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Fax | 502-254-4069
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS CRANFILL
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Credential | DMD
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Telephone | 502-244-2441
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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 |
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License Number State | WV
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