Provider Demographics
NPI:1730218827
Name:CRAVENS, JOESPH D (RDH)
Entity type:Individual
Prefix:
First Name:JOESPH
Middle Name:D
Last Name:CRAVENS
Suffix:
Gender:M
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:HC 3 BOX 3005
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63944-9602
Mailing Address - Country:US
Mailing Address - Phone:573-224-5405
Mailing Address - Fax:
Practice Address - Street 1:109 HWY 51 NORTH
Practice Address - Street 2:
Practice Address - City:MARBLE HILL
Practice Address - State:MO
Practice Address - Zip Code:63764
Practice Address - Country:US
Practice Address - Phone:573-238-2725
Practice Address - Fax:573-238-3795
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003487124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist