MEDICARE: DR. RICHARD ALAN CRAYBAS 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	NY29112	NY

General Provider Information

NPI Number	:	1902920804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD ALAN CRAYBAS DDS.

Provider Business Mailing Address
First Line	:	620 ERIE BLVD W
Second Line	:	#310
City	:	SYRACUSE
State	:	NY
Zip	:	13204-2445
Country	:	US
Telephone Number	:	315-422-9996
Fax Number	:	315-422-9853

Provider Business Practice Location Address
First Line	:	620 ERIE BLVD W
Second Line	:	#310
City	:	SYRACUSE
State	:	NY
Zip	:	13204-2445
Country	:	US
Telephone Number	:	315-673-4092
Fax Number	:	315-422-9853

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

Provider Enumeration Date	:	03/17/2007
Last Update Date	:	07/08/2007

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