Provider Demographics
NPI:1801036736
Name:HILARY GADDIS CRADDOCK, DMD, PA
Entity Type:Organization
Organization Name:HILARY GADDIS CRADDOCK, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-932-5100
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty