Provider Demographics
NPI:1013254218
Name:CRAVEN, SYDNEY MARIE (RDH)
Entity Type:Individual
Prefix:MISS
First Name:SYDNEY
Middle Name:MARIE
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 WADE RD
Mailing Address - Street 2:
Mailing Address - City:SILETZ
Mailing Address - State:OR
Mailing Address - Zip Code:97380
Mailing Address - Country:US
Mailing Address - Phone:541-270-6027
Mailing Address - Fax:
Practice Address - Street 1:584 WADE RD
Practice Address - Street 2:
Practice Address - City:SILETZ
Practice Address - State:OR
Practice Address - Zip Code:97380-9743
Practice Address - Country:US
Practice Address - Phone:541-270-6027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5788124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist