=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750530648
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THOMAS B. CRANFILL & ASSOC. PSC DBA ANCHORAGE DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2008
-----------------------------------------------------
Last Update Date | 09/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12907-B FACTORY LN
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40245-5433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-243-9200
-----------------------------------------------------
Fax | 502-243-9285
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12907-B FACTORY LANE
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40245-5433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-243-9200
-----------------------------------------------------
Fax | 502-243-9285
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. THOMAS B CRANFILL
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 502-243-9200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------