Active NPI
Patricia J Manzo-Craddock, D.D.S.
- Dentist
- Newbury, OH
National Provider Identifier
1861605875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 18595
- Practice address
- 10816 Kinsman Rd.
Newbury, OH 44065 - Phone
- (440) 564-5387
- NPI assigned
- May 7, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 18595 | OH | Primary |
Addresses
Primary practice location
10816 Kinsman Rd.
Newbury, OH 44065
Mailing address
10816 Kinsman Rd.
P.O. Box 342
Newbury, OH 44065
Phone (440) 564-5387
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18595 | OH | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861605875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10816 KINSMAN RD.",
"address_2": "P.O. BOX 342",
"city": "NEWBURY",
"state": "OH",
"postal_code": "44065",
"telephone_number": "440-564-5387",
"fax_number": "440-564-5419"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10816 KINSMAN RD.",
"city": "NEWBURY",
"state": "OH",
"postal_code": "44065",
"telephone_number": "440-564-5387"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANZO-CRADDOCK",
"first_name": "PATRICIA",
"middle_name": "J",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "18595",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newbury, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.