Provider Demographics
NPI:1679588081
Name:CAROL MCCRAW DMD MS PSC
Entity type:Organization
Organization Name:CAROL MCCRAW DMD MS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRAW
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-825-0300
Mailing Address - Street 1:95 YMCA DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-9005
Mailing Address - Country:US
Mailing Address - Phone:270-825-0300
Mailing Address - Fax:
Practice Address - Street 1:95 YMCA DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-9005
Practice Address - Country:US
Practice Address - Phone:270-825-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY64411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty