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General NPI Number Information
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NPI Number | 1821136946
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Entity Type | Individual
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Provider Name | ANITRA MICHELLE CRAIG D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 815 S PINE ST
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City | VIVIAN
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State | LA
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Zip | 71082-3353
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Country | US
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Telephone | 318-375-3183
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Fax | 318-731-3036
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Provider Business Mailing Address
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Address Line | 815 S PINE ST
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City | VIVIAN
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State | LA
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Zip | 71082-3353
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Country | US
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Telephone | 318-375-3183
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Fax | 318-731-3036
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 8327
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6900
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6241
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License Number State | LA
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