Provider Demographics
NPI:1821136946
Name:CRAIG, ANITRA MICHELLE (DDS)
Entity type:Individual
Prefix:
First Name:ANITRA
Middle Name:MICHELLE
Last Name:CRAIG
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:VIVIAN
Mailing Address - State:LA
Mailing Address - Zip Code:71082-3353
Mailing Address - Country:US
Mailing Address - Phone:318-375-3183
Mailing Address - Fax:318-731-3036
Practice Address - Street 1:815 S PINE ST
Practice Address - Street 2:
Practice Address - City:VIVIAN
Practice Address - State:LA
Practice Address - Zip Code:71082-3353
Practice Address - Country:US
Practice Address - Phone:318-375-3183
Practice Address - Fax:318-731-3036
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8327122300000X
OK69001223G0001X
LA62411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1862410Medicaid