Provider Demographics
NPI:1477605509
Name:CRAFT, GREGORY (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:CRAFT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2154 CARTER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7739
Mailing Address - Country:US
Mailing Address - Phone:606-324-6494
Mailing Address - Fax:606-325-4144
Practice Address - Street 1:2154 CARTER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7739
Practice Address - Country:US
Practice Address - Phone:606-324-6494
Practice Address - Fax:606-325-4144
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV42841223P0300X
KY6714, 6011223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics