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General NPI Number Information
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NPI Number | 1679588081
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Entity Type | Organization
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Legal Business Name | CAROL MCCRAW DMD MS PSC
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 95 YMCA DR
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City | MADISONVILLE
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State | KY
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Zip | 42431-9005
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Country | US
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Telephone | 270-825-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 95 YMCA DR
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City | MADISONVILLE
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State | KY
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Zip | 42431-9005
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Country | US
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Telephone | 270-825-0300
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CAROL MCCRAW
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Credential | D.M.D.
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Telephone | 270-825-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 6441
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License Number State | KY
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