Provider Demographics
NPI:1295850469
Name:PACKER, P. CRAIG (DDS)
Entity Type:Individual
Prefix:
First Name:P.
Middle Name:CRAIG
Last Name:PACKER
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:PO BOX 220
Mailing Address - Street 2:88 E STATE ST
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-0220
Mailing Address - Country:US
Mailing Address - Phone:801-451-2341
Mailing Address - Fax:
Practice Address - Street 1:88 E STATE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2343
Practice Address - Country:US
Practice Address - Phone:801-451-2341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT47417931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice