Provider Demographics
NPI:1659006963
Name:CRAIG, DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:CRAIG
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 1:2444 CROWNHEDGE CT
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306-0002
Mailing Address - Country:US
Mailing Address - Phone:586-864-6649
Mailing Address - Fax:
Practice Address - Street 1:118 W SHIAWASSEE AVE
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2006
Practice Address - Country:US
Practice Address - Phone:810-629-2361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016013691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice