Provider Demographics
NPI:1518095579
Name:CRANE, GERALD CLAY
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:CLAY
Last Name:CRANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 W MOUNT HOPE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-2482
Mailing Address - Country:US
Mailing Address - Phone:517-482-8466
Mailing Address - Fax:517-482-8628
Practice Address - Street 1:1850 W MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-2482
Practice Address - Country:US
Practice Address - Phone:517-482-8466
Practice Address - Fax:517-482-8628
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI122241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4054485Medicaid