Provider Demographics
NPI:1235453432
Name:MINICH, CRAIG MICHAEL (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:MICHAEL
Last Name:MINICH
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 CHAGRIN RD
Mailing Address - Street 2:SUITE # 12
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-4701
Mailing Address - Country:US
Mailing Address - Phone:440-287-7398
Mailing Address - Fax:
Practice Address - Street 1:8401 CHAGRIN RD
Practice Address - Street 2:SUITE # 12
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-4701
Practice Address - Country:US
Practice Address - Phone:440-287-7398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0227941223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics