Provider Demographics
NPI:1134143399
Name:WILSON, CRAIG HAROLD (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:HAROLD
Last Name:WILSON
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 1:964 SANFORD AVE.
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-1474
Mailing Address - Country:US
Mailing Address - Phone:973-374-7100
Mailing Address - Fax:973-374-7117
Practice Address - Street 1:964 SANFORD AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-1474
Practice Address - Country:US
Practice Address - Phone:973-374-7100
Practice Address - Fax:973-374-7117
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ94301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice