MEDICARE: DR. PAUL DAVID CRAVEN DDS

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	1223G0001X	General Practice Dentistry	D8945	MN

General Provider Information

NPI Number	:	1467441881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL DAVID CRAVEN DDS

Provider Business Mailing Address
First Line	:	2 S PINE DR
Second Line	:	SUITE M
City	:	CIRCLE PINES
State	:	MN
Zip	:	55014-1798
Country	:	US
Telephone Number	:	763-786-8460
Fax Number	:	763-786-1792

Provider Business Practice Location Address
First Line	:	2 S PINE DR
Second Line	:	SUITE M
City	:	CIRCLE PINES
State	:	MN
Zip	:	55014-1798
Country	:	US
Telephone Number	:	763-786-8460
Fax Number	:	763-786-1792

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	07/08/2007

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