Provider Demographics
NPI:1699037267
Name:CRANE, MITCHELL RAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:RAY
Last Name:CRANE
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 1:2900 BLUECUTT RD STE 2
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1470
Mailing Address - Country:US
Mailing Address - Phone:662-328-1600
Mailing Address - Fax:
Practice Address - Street 1:2900 BLUECUTT RD STE 2
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1470
Practice Address - Country:US
Practice Address - Phone:662-328-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3632-121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice