Provider Demographics
NPI:1235624966
Name:CRAFT, CHAUNCEY LAUREN
Entity type:Individual
Prefix:MISS
First Name:CHAUNCEY
Middle Name:LAUREN
Last Name:CRAFT
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CHAUNCEY
Other - Middle Name:CRAFT
Other - Last Name:BLAKENEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:502 ETERNAL CT
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-4429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:276 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:MS
Practice Address - Zip Code:39153-6016
Practice Address - Country:US
Practice Address - Phone:990-960-1782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4014-18122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist