Provider Demographics
NPI:1104991694
Name:CRAFTON FAMILY DENTISTRY PLLC
Entity type:Organization
Organization Name:CRAFTON FAMILY DENTISTRY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENHAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:CRAFTON
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-860-3368
Mailing Address - Street 1:165 DORSET STREET
Mailing Address - Street 2:
Mailing Address - City:SO BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403
Mailing Address - Country:US
Mailing Address - Phone:802-860-3368
Mailing Address - Fax:802-860-3367
Practice Address - Street 1:165 DORSET ST
Practice Address - Street 2:
Practice Address - City:SO BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403
Practice Address - Country:US
Practice Address - Phone:802-860-3368
Practice Address - Fax:802-860-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT01600022811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty