Provider Demographics
NPI:1942721410
Name:MCCRACKEN, CANDACE LYNN (RDHAP,RDH)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:LYNN
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:RDHAP,RDH
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:LYNN
Other - Last Name:CROWDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9596 HOLLYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PALO CEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:96073-8704
Mailing Address - Country:US
Mailing Address - Phone:530-945-4029
Mailing Address - Fax:
Practice Address - Street 1:5000 BECHELLI LN STE 102
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-3553
Practice Address - Country:US
Practice Address - Phone:530-945-4029
Practice Address - Fax:530-319-3993
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP661124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist