Provider Demographics
NPI:1477661312
Name:RAND, CRAIG B (DMD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:B
Last Name:RAND
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 1:5 S MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-2111
Mailing Address - Country:US
Mailing Address - Phone:207-989-0819
Mailing Address - Fax:207-989-3180
Practice Address - Street 1:5 S MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-2111
Practice Address - Country:US
Practice Address - Phone:207-989-0819
Practice Address - Fax:207-989-3180
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME27491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME200530000Medicaid