Provider Demographics
NPI:1386256931
Name:B. CASEY CRAFTON DDS MS PC
Entity type:Organization
Organization Name:B. CASEY CRAFTON DDS MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:CASEY
Authorized Official - Last Name:CRAFTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-381-0900
Mailing Address - Street 1:10380 OLD COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1882
Mailing Address - Country:US
Mailing Address - Phone:410-381-0900
Mailing Address - Fax:
Practice Address - Street 1:10380 OLD COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1882
Practice Address - Country:US
Practice Address - Phone:410-381-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental