Provider Demographics
NPI:1265513477
Name:CRAINE, STEVEN M (DMD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:CRAINE
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:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:LOXLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36551-0367
Mailing Address - Country:US
Mailing Address - Phone:251-964-6233
Mailing Address - Fax:251-964-7735
Practice Address - Street 1:2122 SOUTH HICKORY STREET
Practice Address - Street 2:
Practice Address - City:LOXLEY
Practice Address - State:AL
Practice Address - Zip Code:36551
Practice Address - Country:US
Practice Address - Phone:251-964-6233
Practice Address - Fax:251-964-7735
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL34911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL91454OtherBLUECROSSBLUESHIELDOFAL