Provider Demographics
NPI:1528939329
Name:CRANE MOUNTAIN LLC
Entity type:Organization
Organization Name:CRANE MOUNTAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHANDLER
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-331-2297
Mailing Address - Street 1:544 N MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-2553
Mailing Address - Country:US
Mailing Address - Phone:530-842-3900
Mailing Address - Fax:
Practice Address - Street 1:544 N MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-2553
Practice Address - Country:US
Practice Address - Phone:530-842-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty