Provider Demographics
NPI:1326408063
Name:CRIDDLE, NATHANIEL (DMD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:CRIDDLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 AEROSPACE MEDICINE SQ/SGPD
Mailing Address - Street 2:340 MAGNOLIA CIRCLE BLDG 1465
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444
Mailing Address - Country:US
Mailing Address - Phone:850-283-7444
Mailing Address - Fax:
Practice Address - Street 1:325 AEROSPACE MEDICINE SQ/SGPD
Practice Address - Street 2:340 MAGNOLIA CIRCLE BLDG 1465
Practice Address - City:TYNDALL AFB
Practice Address - State:FL
Practice Address - Zip Code:32403
Practice Address - Country:US
Practice Address - Phone:850-283-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6890593-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice