Provider Demographics
NPI:1790876464
Name:CRAYLE, JEROME M (DDS)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:M
Last Name:CRAYLE
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:PO BOX 801
Mailing Address - Street 2:2148 HWY 54
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-0801
Mailing Address - Country:US
Mailing Address - Phone:336-578-3896
Mailing Address - Fax:336-578-3814
Practice Address - Street 1:2148 HWY 54
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-0801
Practice Address - Country:US
Practice Address - Phone:336-578-3896
Practice Address - Fax:336-578-3814
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC61111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice