Provider Demographics
NPI:1609866102
Name:CRAMER, JOHN R (DDS MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:CRAMER
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3141 BEAUMONT CENTRE CIR
Mailing Address - Street 2:STE 103
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1934
Mailing Address - Country:US
Mailing Address - Phone:859-219-1913
Mailing Address - Fax:859-219-1317
Practice Address - Street 1:3141 BEAUMONT CENTRE CIR
Practice Address - Street 2:STE 103
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1934
Practice Address - Country:US
Practice Address - Phone:859-219-1913
Practice Address - Fax:859-219-1317
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3835122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64180185Medicaid
KY64180185Medicaid
1256601Medicare ID - Type Unspecified