Provider Demographics
NPI:1902241797
Name:MAHER KRAFT, CARMEN KATHRYN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:KATHRYN
Last Name:MAHER KRAFT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24276 166 ST. AIRPORT RD.
Mailing Address - Street 2:CRST DENTAL CLINIC
Mailing Address - City:EAGLE BUTTE
Mailing Address - State:SD
Mailing Address - Zip Code:57625-0590
Mailing Address - Country:US
Mailing Address - Phone:605-964-0736
Mailing Address - Fax:
Practice Address - Street 1:24276 166TH ST. AIRPORT RD.
Practice Address - Street 2:DENTAL CLINIC
Practice Address - City:EAGLE BUTTE
Practice Address - State:SD
Practice Address - Zip Code:57625-0590
Practice Address - Country:US
Practice Address - Phone:605-964-0736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDDH1379124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist