Provider Demographics
NPI:1265628705
Name:MCCRACKEN, RALPH S JR (DDS)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:S
Last Name:MCCRACKEN
Suffix:JR
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 1:21 MAYO DR
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-1511
Mailing Address - Country:US
Mailing Address - Phone:508-829-3911
Mailing Address - Fax:
Practice Address - Street 1:21 MAYO DR
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1511
Practice Address - Country:US
Practice Address - Phone:508-829-3911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14224122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist