Provider Demographics
NPI:1396747705
Name:INGLIS, CRAIG MITCHELL (DMD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:MITCHELL
Last Name:INGLIS
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 1:283 WOODBRIER
Mailing Address - Street 2:
Mailing Address - City:SAUTEE NACOOCHEE
Mailing Address - State:GA
Mailing Address - Zip Code:30571-2056
Mailing Address - Country:US
Mailing Address - Phone:706-878-1934
Mailing Address - Fax:
Practice Address - Street 1:1290 ATHENS ST
Practice Address - Street 2:HALL COUNTY HEALTH DEPARTMENT
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30507-7000
Practice Address - Country:US
Practice Address - Phone:770-531-5609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0088781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00924679AMedicaid
GADN008878OtherDENTIST LICENSE
GA00924679CMedicaid
GA00924679BMedicaid