MEDICARE: DR. CRAIG A. MCEWAN D.D.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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	6962	IN

General Provider Information

NPI Number	:	1700826799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG A. MCEWAN D.D.S.

Provider Business Mailing Address
First Line	:	3012 FRANKLIN ST
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-6144
Country	:	US
Telephone Number	:	219-879-4551
Fax Number	:	219-879-4552

Provider Business Practice Location Address
First Line	:	3012 FRANKLIN ST
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-6144
Country	:	US
Telephone Number	:	219-879-4551
Fax Number	:	219-879-4552

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/08/2007

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