Provider Demographics
NPI:1396867495
Name:CRANE, MARK DAVID (DDS, MS, PC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:CRANE
Suffix:
Gender:M
Credentials:DDS, MS, PC
Other - Prefix:
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Mailing Address - Street 1:4144 TIMBERLINE RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-6029
Mailing Address - Country:US
Mailing Address - Phone:970-226-6443
Mailing Address - Fax:970-266-2741
Practice Address - Street 1:4144 TIMBERLINE RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-6029
Practice Address - Country:US
Practice Address - Phone:970-226-6443
Practice Address - Fax:970-266-2741
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics