Provider Demographics
NPI:1649566860
Name:CRIGLER, MARY KATHRYN (DDS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:CRIGLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-3107
Mailing Address - Country:US
Mailing Address - Phone:318-350-6873
Mailing Address - Fax:318-350-6874
Practice Address - Street 1:106 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5332
Practice Address - Country:US
Practice Address - Phone:318-350-6873
Practice Address - Fax:318-350-6874
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6195122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist