Provider Demographics
NPI:1558480426
Name:CRARY, JOHN CHARLES (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:CRARY
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 1:2 WILLETT ST
Mailing Address - Street 2:
Mailing Address - City:FORT PLAIN
Mailing Address - State:NY
Mailing Address - Zip Code:13339-1115
Mailing Address - Country:US
Mailing Address - Phone:518-993-2514
Mailing Address - Fax:518-993-3818
Practice Address - Street 1:2 WILLETT ST
Practice Address - Street 2:
Practice Address - City:FORT PLAIN
Practice Address - State:NY
Practice Address - Zip Code:13339-1115
Practice Address - Country:US
Practice Address - Phone:518-993-2514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051914-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice