Provider Demographics
NPI:1275629875
Name:CRADDOCK, JOSEPH ALLAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ALLAN
Last Name:CRADDOCK
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 1:3325 E. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:NY
Mailing Address - Zip Code:14011
Mailing Address - Country:US
Mailing Address - Phone:585-591-3509
Mailing Address - Fax:585-591-2614
Practice Address - Street 1:3325 E MAIN STREET RD
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:NY
Practice Address - Zip Code:14011
Practice Address - Country:US
Practice Address - Phone:585-591-1404
Practice Address - Fax:585-591-2614
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0481251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice