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Organization
J. ANDREW CRAYCROFT D.M.D. INC.
Active
Organization
J. ANDREW CRAYCROFT D.M.D. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANET M. LONGEST (OFFICE MGR.)
(270) 781-4997
Entity
Organization
Contact information
Practice address
1711 ASHLEY CIR, SUITE 3, BOWLING GREEN, KY 42104-5801
(270) 781-4997
(270) 781-8557
Mailing address
1711 ASHLEY CIR, SUITE 3, BOWLING GREEN, KY 42104-5801
(270) 781-4997
(270) 781-8557
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6137
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21062
MCNA DENTAL
—
05
—
60061371
—
KY
01
—
60633DM
AVESIS
—
Enumeration date
10/26/2011
Last updated
10/26/2011
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