Provider Demographics
NPI:1962687608
Name:CRAYGRAFT LLC
Entity Type:Organization
Organization Name:CRAYGRAFT LLC
Other - Org Name:PREMIERE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-621-5304
Mailing Address - Street 1:9200 HIGHWAY 119
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-5337
Mailing Address - Country:US
Mailing Address - Phone:205-621-5304
Mailing Address - Fax:
Practice Address - Street 1:9200 HIGHWAY 119
Practice Address - Street 2:SUITE 200
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-5337
Practice Address - Country:US
Practice Address - Phone:205-621-5304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL50131223G0001X
AL50061223G0001X
AL39751223G0001X
AL41871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty