Provider Demographics
NPI:1124165188
Name:CRAVEN, BRIAN P (DDS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:P
Last Name:CRAVEN
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 1:4 LINE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01073-9441
Mailing Address - Country:US
Mailing Address - Phone:413-527-5205
Mailing Address - Fax:413-527-7822
Practice Address - Street 1:4 LINE ST
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01073-9441
Practice Address - Country:US
Practice Address - Phone:413-527-5205
Practice Address - Fax:413-527-7822
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice