Provider Demographics
NPI:1124033535
Name:MCCRAW, CAROL ANNA (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANNA
Last Name:MCCRAW
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 PRINCETON PL
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-7551
Mailing Address - Country:US
Mailing Address - Phone:270-886-0114
Mailing Address - Fax:
Practice Address - Street 1:319 COOL WATER CT
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-8738
Practice Address - Country:US
Practice Address - Phone:270-886-0114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY64411223X0400X
TN69051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics