Provider Demographics
NPI:1740389238
Name:CRANE, JOEL PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:PATRICK
Last Name:CRANE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:WI
Mailing Address - Zip Code:53555-1121
Mailing Address - Country:US
Mailing Address - Phone:608-592-4398
Mailing Address - Fax:608-592-5245
Practice Address - Street 1:216 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:WI
Practice Address - Zip Code:53555-1121
Practice Address - Country:US
Practice Address - Phone:608-592-4398
Practice Address - Fax:608-592-5245
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI58950151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33796500Medicaid