John Ellis Craig, DDS
Individual provider Active NPI Dentist · Macclenny, FL
NPI 1720152192 · NPPES record last updated Jan 28, 2013
Key facts
- NPI
- 1720152192
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DN 7228 (FL)
- Practice address
- 480 W Lowder St
Macclenny, FL 32063-2664 - Phone
- (904) 259-6291
- Fax
- (904) 259-4761
- NPI assigned
- Nov 20, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN 7228 | FL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| West Side Dental Associates | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN 7228 | FL | Yes |
Addresses
Primary practice location
480 W Lowder St
Macclenny, FL 32063-2664
Mailing address
6223 Sauterne Dr
Jacksonville, FL 32210-7728
Phone (904) 771-0568
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002016100 | Medicaid | FL |
Other providers in Macclenny, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.