Provider Demographics
NPI:1851480115
Name:MCCRACKEN, LOREN MEREDITH (DMD)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:MEREDITH
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 HARGROVE RD E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-2612
Mailing Address - Country:US
Mailing Address - Phone:205-562-7002
Mailing Address - Fax:205-562-6903
Practice Address - Street 1:2350 HARGROVE RD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-2612
Practice Address - Country:US
Practice Address - Phone:205-562-7002
Practice Address - Fax:205-562-6903
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5230122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009964985Medicaid