Provider Demographics
NPI:1538292487
Name:MUNDY, CRAIG R (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:R
Last Name:MUNDY
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 1:5446 N PALM AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-1945
Mailing Address - Country:US
Mailing Address - Phone:559-261-9700
Mailing Address - Fax:559-261-0661
Practice Address - Street 1:5446 N PALM AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-1945
Practice Address - Country:US
Practice Address - Phone:559-261-9700
Practice Address - Fax:559-261-0661
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice