Provider Demographics
NPI:1831319797
Name:CRAIG, BERKLEY GORDON III (DDS)
Entity Type:Individual
Prefix:DR
First Name:BERKLEY
Middle Name:GORDON
Last Name:CRAIG
Suffix:III
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 1:714 N ALLEGHANEY AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4410
Mailing Address - Country:US
Mailing Address - Phone:432-337-2042
Mailing Address - Fax:432-337-2869
Practice Address - Street 1:714 N ALLEGHANEY AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4410
Practice Address - Country:US
Practice Address - Phone:432-337-2042
Practice Address - Fax:432-337-2869
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17949122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist