Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 052263-1 | NY |
Y | 1223X0400X | Orthodontists | 7151 | LA |
NPI | 1033231394 |
---|---|
Provider Name | Dr. Karsten Craven |
First Address | Baton Rouge, LA 70810-3263 |
Second Address | Lafayette, LA 70501-1927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2007 |
Last Update Date | 05/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033231394 | (05) | NY |