Provider Demographics
NPI:1124041769
Name:CRAIG, RICHARD A (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:CRAIG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14831 W 159TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60491-9008
Mailing Address - Country:US
Mailing Address - Phone:312-676-9892
Mailing Address - Fax:815-744-7059
Practice Address - Street 1:14831 W 159TH ST STE 1
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60491-9008
Practice Address - Country:US
Practice Address - Phone:815-483-2980
Practice Address - Fax:815-744-7059
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190142841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1053431981OtherGROUP NPI
1205145554OtherPRACTICE LOCATION TYPE II NPI
1295165439OtherPRACTICE LOCATION TYPE II NPI
1063649770OtherGROUP NPI
1760882005OtherPRACTICE LOCATION TYPE II NPI
1306177241OtherPRACTICE LOCATION TYPE II NPI
1508198474OtherPRACTICE LOCATION TYPE II NPI
1306177241OtherPRACTICE LOCATION TYPE II NPI
1760882005OtherPRACTICE LOCATION TYPE II NPI
1306177241OtherPRACTICE LOCATION TYPE II NPI