Individual
CRAIG H FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
12776 S WEST BAY SHORE DR, TRAVERSE CITY, MI 49684-5451
(231) 946-3512
(231) 946-1908
Mailing address
1010 CASS ST, TRAVERSE CITY, MI 49684-3234
(231) 392-5810
(231) 946-1908
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2901018208
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003095605
NPI GROUP #
MI
05
—
4756423
—
MI
05
—
4756432
—
MI
Enumeration date
05/19/2006
Last updated
12/27/2007
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