Provider Demographics
NPI:1689713570
Name:KRAW, ALLAN GORDON (DDS)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:GORDON
Last Name:KRAW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 STAGECOACH ST SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-4836
Mailing Address - Country:US
Mailing Address - Phone:505-565-9065
Mailing Address - Fax:
Practice Address - Street 1:RESERVATIION HWY. 169
Practice Address - Street 2:
Practice Address - City:MAGDALENA
Practice Address - State:NM
Practice Address - Zip Code:87825
Practice Address - Country:US
Practice Address - Phone:505-854-2610
Practice Address - Fax:505-854-2648
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD17851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice