Provider Demographics
NPI:1700184496
Name:CRAIG E. FURY DDS AND DAVID PRIESTLY DDS, PROFESSIONAL DENTAL CORPORAT
Entity Type:Organization
Organization Name:CRAIG E. FURY DDS AND DAVID PRIESTLY DDS, PROFESSIONAL DENTAL CORPORAT
Other - Org Name:PROFESSIONAL DENTAL CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CO OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRIESTLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-279-3232
Mailing Address - Street 1:1003 W JUDGE PEREZ DR
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-4703
Mailing Address - Country:US
Mailing Address - Phone:504-279-3232
Mailing Address - Fax:504-277-5318
Practice Address - Street 1:1003 W JUDGE PEREZ DR
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-4703
Practice Address - Country:US
Practice Address - Phone:504-279-3232
Practice Address - Fax:504-277-5318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty