Provider Demographics
NPI:1700439544
Name:CRAYCROFT PRIME DENTAL, P.C.
Entity type:Organization
Organization Name:CRAYCROFT PRIME DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KYM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-225-9244
Mailing Address - Street 1:12930 N TOPANGA DR
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-8725
Mailing Address - Country:US
Mailing Address - Phone:716-225-9244
Mailing Address - Fax:
Practice Address - Street 1:1840 N CRAYCROFT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3702
Practice Address - Country:US
Practice Address - Phone:520-886-2822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty