Provider Demographics
NPI:1457514945
Name:FANTI, CRAIG (DMD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:FANTI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 FOSTER RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-6112
Mailing Address - Country:US
Mailing Address - Phone:184-522-7582
Mailing Address - Fax:
Practice Address - Street 1:46 FOSTER RD
Practice Address - Street 2:SUITE 4
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-6112
Practice Address - Country:US
Practice Address - Phone:845-227-5826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-06
Last Update Date:2008-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04228211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice