Provider Demographics
NPI:1972583334
Name:CRAIG A. FEDORE,D.D.S., P.C.
Entity Type:Organization
Organization Name:CRAIG A. FEDORE,D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:FEDORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-337-0351
Mailing Address - Street 1:714 ABBOTT RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-3101
Mailing Address - Country:US
Mailing Address - Phone:517-332-7035
Mailing Address - Fax:517-337-5610
Practice Address - Street 1:714 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3101
Practice Address - Country:US
Practice Address - Phone:517-337-0351
Practice Address - Fax:517-337-5610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI131431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty