Provider Demographics
NPI:1831202589
Name:BOOTH, CRAIG EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:EDWARD
Last Name:BOOTH
Suffix:
Gender:M
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:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:UNALASKA
Mailing Address - State:AK
Mailing Address - Zip Code:99685-0061
Mailing Address - Country:US
Mailing Address - Phone:907-581-1202
Mailing Address - Fax:907-581-2331
Practice Address - Street 1:34 LAVELLE LANE
Practice Address - Street 2:
Practice Address - City:UNALASKA
Practice Address - State:AK
Practice Address - Zip Code:99685-0061
Practice Address - Country:US
Practice Address - Phone:907-581-1202
Practice Address - Fax:907-581-2331
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice