Willie Cradoc III, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

26286 Issued in TX

Practice address

5614 W Grand Pkwy S
Suite 120
Richmond, TX 77406-5820

Phone

(310) 909-3870

NPI assigned

Mar 26, 2011

Last updated

Mar 26, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301097600000",
    "number": "1780983957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2272 LAKE TERRACE DR",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917091763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5614 W GRAND PKWY S",
            "address_2": "SUITE 120",
            "city": "RICHMOND",
            "state": "TX",
            "postal_code": "774065820",
            "telephone_number": "310-909-3870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRADOC",
        "first_name": "WILLIE",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-03-26",
        "last_updated": "2011-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "26286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Richmond, TX
• Providers in Richmond, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.