MEDICARE: DR. JOE HOWARD CRAIN D.D.S., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	10034	TX

General Provider Information

NPI Number	:	1346468196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOE HOWARD CRAIN D.D.S., M.S.

Provider Business Mailing Address
First Line	:	4375 S HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4917
Country	:	US
Telephone Number	:	817-926-9777
Fax Number	:	817-926-7382

Provider Business Practice Location Address
First Line	:	4375 S HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4917
Country	:	US
Telephone Number	:	817-926-9777
Fax Number	:	817-926-7382

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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