Provider Demographics
NPI:1356478697
Name:CRADDOCK, HILLARY (DMD)
Entity Type:Individual
Prefix:DR
First Name:HILLARY
Middle Name:
Last Name:CRADDOCK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W HARPER ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:39218-4406
Mailing Address - Country:US
Mailing Address - Phone:601-932-5100
Mailing Address - Fax:601-939-3080
Practice Address - Street 1:125 W HARPER ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MS
Practice Address - Zip Code:39218-4406
Practice Address - Country:US
Practice Address - Phone:601-932-5100
Practice Address - Fax:601-939-3080
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3326051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice