Provider Demographics
NPI:1033231394
Name:CRAVEN, KARSTEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARSTEN
Middle Name:
Last Name:CRAVEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12342 WHITE CHAPEL AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-3263
Mailing Address - Country:US
Mailing Address - Phone:646-670-7914
Mailing Address - Fax:
Practice Address - Street 1:2001 NW EVANGELINE TRWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-1927
Practice Address - Country:US
Practice Address - Phone:337-427-8840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052263-1122300000X
LA71511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1033231394Medicaid