Provider Demographics
NPI:1134378516
Name:CRAIGHEAD, JUSTIN C (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:C
Last Name:CRAIGHEAD
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 NW 43RD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6190
Mailing Address - Country:US
Mailing Address - Phone:352-372-3600
Mailing Address - Fax:
Practice Address - Street 1:3720 NW 43RD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6190
Practice Address - Country:US
Practice Address - Phone:352-372-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10035122300000X
FLDN18965122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist